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TOWN OF DUNN PARCEL #: 28-0610- I 3 -- a� <br /> DRIVEWAY CONSTRUCTION PERMIT APPLICATION PERMIT #: <br /> SECTION 1- SITE VERIFICATION <br /> Applicant Name: )43E./ z 0 )40 f'Y1?..c 1 ,P-_ VA rL l Vni' Dr Date: 1 1•-I- -- l,� <br /> Address: 41110 &?7 A(, & O U jL? C'tJTTA(>F. G IS fL Phone#:/.U1' (2 LQ O-'3 FG <br /> Purpose: W/Xf Residential ❑ Field Road Access L ❑ 6tlier`2 <br /> (Bldg.site verification not required) <br /> Property Owner's Name: f\/ii<, A)e,AE.IL_ s <br /> Proposed Driveway Location: -.71 4 ';,;1'-/ %,1-- c:, -ii.,, ii\I 1-.- - <br /> (!LL/ I ,'- 1'/Lb k.4) <br /> Driveway will provide access to: ❑ US/Co. Hwy Permit# ( . own Rd. ❑ Private Rd. <br /> Does property owner own proposed driveway road frontage? ❑ yes ❑ no no, attach copy of easement.) <br /> Bldg. Site Verification Date Comments <br /> , <br /> SECTION 2 - SUBMITTAL REQUIREMENTS& CONSTRUCTION COMMENCEMENT APPROVAL <br /> Driveway Construction Permit Application must include the following checked information: <br /> Diagram Showing: Other: <br /> O Property slopes. 0 Copy of any required Dane Co. erosion control plan. <br /> ❑ Driveway slope. h Other Cam rc tvi G K c r ee c et u e df <br /> ❑ Driveway turnaround. <br /> 771? <br /> ❑ Location& structure of retaining walls. . <br /> 0 Length,width&radius of driveway curves. ." <br /> ❑ Driveway cross section showing depth& fill material.f -- @ (' <br /> ❑ Drainage culvert;t r N. ft. length, ( :�(_ ... in. diameter. i (i (.t 'Z l�`''-� <br /> ❑ Driveway relationship to property lines, structures&roads. Center of driveway 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 tp construct 6-described work in accordance'with the plans and specifications filed. <br /> /j fir /l 1Z ` jf.T.- <br /> Signature df Applicant Date <br /> e <br /> 'ublic Works Foreman Initial Construction Approval Date Permit Issued Permit Fee <br /> {. j <br /> SECTION 3 - FINAL APF RO�f'AL -4"/ L. i7 <br /> ❑ The Town of Dunn has inspected the above field road and determination has been made that it meets \I \ 1 <br /> the Town's minimum standards. The field road is authorized for agricultural use. <br /> O 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 /> A <br /> Signature of Public Works Foreman <br /> White - Town Yellow- Applicant Pink-Dane Co. Zoning <br />