Laserfiche WebLink
TOWN OF VERONA <br /> 0 DRIVEWAY CONSTRUCTION PERMIT APPLICATION • <br /> (Driveway Ordinance #2009-02B) <br /> Applications for a drivoN ay construction permit cannot be processed until the lot is legally created. A <br /> certified surrey map (CSNI) or final plat that has been signed and recorded must be on file with the Town <br /> before a driveway application may be processed. <br /> This completed driveway application form must be filed with the Town Clerk/Treasurer along with a <br /> nonrefundable S250.00 application fee and applicable escrow deposit. (See Resolution :010-03 [scro•.y <br /> Requirements.) Escrow balances may be refundable as provided in the Town's driveway ordinance. <br /> Note: A building permit niav not he issued for any parcel without an approved l o«n of Verona drive‘‘ay <br /> construction permit. <br /> REQUIRED INFORMATION `` 1f I `` }� '� l� f• <br /> Landowner:J`-1' r�4 2c=.c�`r C'1A, L L��l d c-- :\pplicanv'A�gent: J�S �1(1 f,c t1 iPk.-�1.��,�� OM IG- <br /> Address: L Gt., Af C(t C 4 C Address:VC'C' �� ice H SI1 P t t r <br /> Phone: 0g'-.7L'124l: 60e-c7 >/o `f Phone: al- 'Y11 6 Cell: 75`f--r,sK <br /> r <br /> Email: (c2vtn�. i"o>t °Sp. r_A'�.,. r�-�,.�(s.cQ Email: ��E't'�1?k' C' �j�t'G�1'�t_�� f .C.4 el <br /> Mailing.address for Completed Permits: Name: <br /> Address: City: State Zip <br /> Parcel #062-060S i='� Road to be Accessed by Driveway: r: <br /> Legal Description: <br /> Type of Proposed Use: NEW - "'CHANGE of Use - RELOCATE - iMPRO\'E\tL\T or <br /> CULVERT REPLACEMENT (circle one (I fI: <br /> t'Cn::n e Use applies should a Dane Count Coniitional Ilse Permit he required.) <br /> • Aerieulture 51000.00 0 Field Road 51000.00) ), Residential S117)00.00 <br /> O Commercial S15i11(.00 El Industrial S11(iu.00 El Temporary/Access Drive yi5110.(j) <br /> O Improvement or Culvert Repl,ceme:,a 530{1.(.1t:) <br /> ay i.enath S.:. Width:dtth: r D 'f rcct l.'.istin_ • <br /> I_>::stin_ Cub. rt: r IN: • <br /> ,• <br /> Data• el {):'0170: d od <br />