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t r S eAtYt-o- i` <br /> Name of Applicant <br /> PART II: (Permit) <br /> 1. Town Board denied driveway permit. Date:, <br /> approved permit. Date: 5///70q <br /> 2. Engineer's plan is not required. <br /> is required '► A <br /> Date of approval by Town Board J�/i1/O 9 <br /> 3. A culvert at the ditch line where the driveway meets the public <br /> road <br /> is required. <br /> is not required. ' <br /> ("r---- - ss 4 /1g £7''/© ' <br /> Signature of Town Board--'LrPerson Date <br /> PART 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 /> 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 /> V <br />