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Additional Comments: 5iAL4/4- ()Ct l t1 e 5 t chat-t' 1,n1 p akt 42/1 15 The undersigned hereby applies for a driveway permit at the above location in accordance with the Town of Verona Driveway Ordinance 2004-02. Landowner or Applicant Signature: Date: `tf Z,6 t fa (If applicant is not the property owner, attach• rrotar tf stater ent authorising applicant to act as`land vner's agent.) REQUIRED APPLICATION MATERIALS 1) The required application fee and escrow deposit. 2) A scale drawing of the property parcel. Be sure to include the following,when submitting your driveway construction drawing or diagram. • The relationship of the driveway to property lines,structures and existing private roads and public highways. • The proposed or existing driveway location.Distances from the existing property lines to the centerline of the driveway shall be dimensioned to establish the driveway location. The length, width,and radius of all curves of the driveway shall be included. • The width of the driveway at the edge of roadway shall be dimensioned. • The slope of the driveway and the slopes on your property. • All buildings existing and any new buildings intended to be added to the parcel. • The location and size of any culverts. • The location and structure of any retaining walls. 3) An approved copy of a Dane County erosion control plan,which includes the drive or a copy of an approved erosion control plan for 1 &2 family dwelling construction site plan. RETURN COMPLETED APPLICATION TO: Tammy Dresser Town of Verona 335 N.Nine Mound Rd Verona,WI 53593-1035 608-845-7187/608-845-7143 Fax OFFICE USE ONLY: NONREFUNDABLE APPLICATION FEE RECEIVED: AMOUNT: $ DATE: ESCROW DEPOSIT RECEIVED: AMOUNT:S DATE: Plan Reviewed—Site Visit Date: Verona Fire Department Review: Date: ❑ Approved ❑ Denied DETERMINATION: NEXT TB MEETING: (Rev.04112)