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TOWN OF DUNN PARCEL #: 28-0610- `'? 50"V <br /> DRIVEWAY CONSTRUCTION PERMIT APPLICATION PERMIT #: /0 3/ <br /> SECTION 1- SITE VERIFICATION '/ zy'ariio-Zri-}rso"y <br /> Applicant Name: ,pA„�,� t �1 p.c Date: v L 26 <br /> Address: Zr,,//y /?.,,,1 '.ir Y.� �tI Phone#: :1 • 34/1- <br /> Purpose: y.Residential ❑ Field Road Access ❑ Other U/4-,' <br /> (Bldg. site verification not required) <br /> Property Owner's Name: r■J r7” <br /> Proposed Driveway Location: <br /> Driveway will provide access to: ❑ US/Co. Hwy Permit# ❑ Town Rd. "S Private Rd. <br /> Does property owner own proposed driveway road frontage?je yes ❑ no (If no, attach copy of easement.) <br /> Bldg.Site Verification Date Comments <br /> SECTION 2 - SUBMITTAL REQUIREMENTS& CONSTRUCTION COMMENCEMENT 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. ❑ Other <br /> ❑ Driveway turnaround. <br /> ❑ Location& structure of retaining walls. <br /> ❑ Length,width&radius of driveway curves. . <br /> 0 Driveway cross section showing depth& fill material. / <br /> ❑ Drainage culvert, ft. length, in. diameter. <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 to construct the described work in accordance with the plans and specifications filed. <br /> Signature of Applicant Date <br /> Public Works Foreman Initial Construction Approval Date Permit Issued Permit Fee <br /> 4_ $ <br /> SECTION 3 - FINAL APPROVAL <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 /> , 1Y-9/ F/-75.9 <br />