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IF <br />TOWN OF DUNN <br />DRIVEWAY CONSTRUCTION PERMIT APPLICATION <br />SECTION 1 -SITE VERIFICATION <br />PARCEL #: 14-0610- 021-7;06 "Q <br />PERMIT #: <br />Applicant Name: .��'j" S �A'J%yL�. /QJ If(-4--yj <br />Address: 4�jrn)j 1�LT <br />Purpose <br />© Residential ❑ Field Road Access ❑ Other <br />(Bldg. site verification not required) <br />Date: ///11 103 <br />Phone#: 222- 17 7-j <br />Property Owner's Name:- L, A 1-0/1i <br />Proposed Driveway Location:/z <br />(�/C,(Jf <br />Driveway will provide access to: ❑ US/Co. Hwy Permit # Town Rd. ❑ Private Rd. <br />Does property owner own proposed driveway road frontage?X yes ❑ no (If no, attach copy of easement.) <br />BldgA. <br />Verification {D/atei J C,ronimpents <br />SECTION 2 - SUBMITTAL REQUIREMENTS & CONSTRUCTION COMMEND" EMENT APPROVAL <br />Driveway Construction Permit Application must include the following checked information: <br />Diagram Showing: Other: <br />❑ Property slopes. ❑ Copy of any required Dane Co. erosion control plan. <br />❑ Driveway slope. l Other CG z.L <br />❑ 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, :a S ft. length, _�2 f in. diameter. LJ <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 reby agree4o construct the described work in accordance with the plans and specifications filed. <br />Signature of Applicant Date <br />SECTION 3 - FINALAPPROVAL <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 />Signature of Public Works Foreman <br />White - Town Yellow - Applicant Pink - Dane Co. Zoning <br />