Laserfiche WebLink
'bJ5j <br /> DRIVEWAY CONSTRUCTION PERMIT APPLICATION <br /> TOWN OF BERRY—DANE COUNTY, WISCONSIN <br /> _� pp ( 1 <br /> Applicant: Name: qv, ( \ ` _i•,(,I,� , / ✓1 w <br /> Current Mailing Address: i :="-. 6( ,l 4 1 67 <br /> City, State, ZIP: L'UCI()ACV Q Q, '■_,/ l_ t 7 j C `( <br /> 1 // <br /> ��,/� - j c• 1. y. <br /> Phone Number:60 _ 5 01 A ail: ,A. G ll-( <br /> I <br /> Specific Site Location/Nearby Roads: O r / i. 1 <br /> Parcel it: CCr \ I03 ( bV.-:7- Z4 il — Xlbv_O <br /> My signature below indicates that: <br /> I have received a copy of the Driveway Ordinance and the Applications Guide, and that <br /> I have attached the information as requested for driveway permits in Section A(2) in the Driveway <br /> Permit section of the Applications Guide, and that <br /> I agree to construct the driveway in accordance with Town of Berry Driveway Permit Ordinance 301.1 <br /> and to follow the plans and other documents as approve by the town board which become part of this permit, <br /> and that ✓ <br /> I have paid the application fee of$ J C , `, to the town Clerk/Treasurer,and that <br /> I hereby give permission to the Town Board and/or their representative which could he the Plan <br /> Commission or other inspector authorized by the town board to enter the property in order to evaluate the site of <br /> the proposed driveway a : o verify compliance with and/or to enforce the Driveway Ordinance. <br /> IlkApplication Signature: b. A. Date: 2— / / (S ''! <br /> Board decision: Approve / Deny Date 3 / I (D / I <br /> ii <br /> Culvert required in right-of-way Yes No / Size <br /> l <br /> Engineering Plan required? Yes No / 1 <br /> Additional Requirements? Yes _if yes see attached requirements No <br /> fa <br /> , <br /> Driveway construction must begin by Date J / I (o / I (o <br /> i <br /> Driveway Permit expiration Date 3 / l (D / 17 �' <br /> r <br /> Amount of cash bond quired: $ 4 . Any cash bond required must be provided to the Town <br /> Clerk/Treasurer before t e pert 'is issued. <br /> Chair Signature: _ __ Date / /L / lb <br /> il <br /> Permit issued by: Clerk Signature 6n^ ,,, Ai,:,, Date 3 I/ (o /I <br /> Permit is not valid un ess signed by the Applicant,Town Chair and Town Clerk il <br /> Final inspection approval by: Signature Date / / 11 <br /> Cash Bond returned$ with interest$ Date / / I <br /> ■ <br /> Original Copy—Office Files Copy-Applicant <br /> I:. <br /> 1. <br /> !l <br /> 1 <br />