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Name of Applicant 406enecijii-- eicit <br /> PART II: (Permit) <br /> 1. Town Board denied driveway permit. Date: <br /> approved permit. Date: /0 S <br /> t . <br /> 2. Engineer's plan is not required. <br /> is required. <br /> Date of approval by Town Board r/6//..s <br /> 3. A culvert at the ditch line where the driveway meets the public <br /> road <br /> J, . . <br /> s required. <br /> is not required. ' <br /> 0--l- vv:-Signature of Town rd Chairperson Date <br /> PAR ' III: (Inspection of Completed Driveway) <br /> Driveway is in accordance with plans approved by the Town Board <br /> Driveway. is not acceptable. <br /> Owner will make required improvements by <br /> Comments <br /> • <br /> Signature of Town Chairperson Date <br /> NOTE: This form fully completed must be presented to the Dane County <br /> Zoning and Natural Resources Committee before the County will <br /> issue any required building permits. <br />