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Name of Applicant 1 ►it 1W,a1 00or1 LL( <br /> PART II: (Permit) <br /> 1. Town Board denied driveway permit. Date: <br /> X. approved permit. <br /> Date: <br /> ate: <br /> 2. Engineer's plan is . �iy �o <br /> is required. <br /> Date of approval by Town Board <br /> 3. A culvert at the ditch line where the driveway meets the public <br /> road <br /> is required. <br /> is not required. <br /> C air person <br /> Dat <br /> Signature of Town P <br /> PART III: (Inspection of Completed Driveway) <br /> Driveway is in accordance with plans approved by the Town Board <br /> Driveway- is not acceptable. <br /> Owner will make required improvements by <br /> Comments <br /> Signature of Town Chairperson Date • <br /> NOTE: This form fully completed must be presented to the Dane County <br /> Zoning and Natural Resources Committee before the County will <br /> issue any required building permits. <br /> ti <br />