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TOWN OF DUNN PARCEL #: 28-0610- ,A ; _ r`''r t <br /> DRIVEWAY CONSTRUCTION PERMIT APPLICATION PERMIT #: / (.''/(.p <br /> SECTION 1- SITE VERIFICATION - <br /> Applicant Name: iQ 'J' 1---=.- 1) S I-1 t R s- ✓V Date: 5f(:- / i `, <br /> r <br /> Address: f <br /> 7 0 /„/,/ 41 Phone#:&O S'- `r '/-- k'' - ,{:r._. <br /> Purpose: A Residential ❑ Field Road Access ❑ Other (Q 0 G'— <br /> (Bldg.site verification not required) �j cs <br /> Property Owner's Name: /-� A) b f4 r• y 11 N i E T2... L. d s Ion s <br /> Proposed Driveway Location: <br /> 7,7 7 LJ I o 2 f c I <br /> Driveway will provide access to: ❑ US/Co. Hwy Permit# ,Town Rd. ❑ Private Rd. <br /> Does property owner own proposed driveway road frontage? ,® yes ❑ no (If no,attach copy of easement.) <br /> Bids.Site Verification Date Comments # Z.,;.-i <br /> }� <br /> SECTION 2 - SUBMITTAL REQUIREMENTS& CONSTRUCTION COMMENCEMENT APPROVAL <br /> Driveway Construction Permit Application must include the following checked information: 4. <br /> Diagram Showing: Other: <br /> ❑ Property slopes. ❑ Copy of any required Dane Co. erosion control plan. <br /> ❑ Driveway slope. y Other P-4, _ V <br /> LI Driveway turnaround. <br /> ❑ Location& structure of retaining walls. <br /> ❑ Length,width&radius of driveway curves. <br /> ❑ Driveway cross section showing depth&fill material. ' <br /> ❑ Drainage culvert, ft. length, in. diameter. , <br /> ❑ Driveway relationship to property lines, structures&roads. Center of driveway V feet from <br /> The undersigned applicant as owner,or as owner's agent, does hereby attest that all the information provided is true and <br /> accurate and does hereby agree to construct the described work in accordance with the plans filed. <br /> e <br /> Signature of Applicant D e <br /> Pu lie Works Form Initial Construction Approval Date Permit Issued Permit Fee <br /> ...: .,*( k a. ,f l 1-1 i,f ,A $ /C` . f 0 <br /> SECTION 3 - FINAL APPROVAL i" <br /> t <br /> ❑ The Town of Dunn has inspected the above field road and determination has been made that it meets <br /> the Town's minimum standards. The field road is authorized for agricultural use. <br /> ❑ The Town of Dunn has inspected the above driveway and determination has been made that the <br /> driveway meets the Town's minimum standards. The Dane County Zoning Office is hereby authorized <br /> to issue a building permit this day of , <br /> 1 Signature of Public Works Foreman <br /> e <br /> White - Town Yellow-Applicant Pink- Dane Co. Zoning <br />