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TOWN OF DUNN PARCEL #: 28-0610- <br /> DRIVEWAY CONSTRUCTION PERMIT APPLICATION PERMIT #: <br /> SECTION 1- SITE VERIFICATION <br /> Applicant Name: "rev)r- 4 j r Date: 6- <br /> Address: ' oq Gtio.r(e.6 Lane /I/56 1ourtii t°' Phone#: 6044-ai�-`fa 19 <br /> Purpose: CI Residential ❑ Field Road Access )J le Other <br /> (Bldg. site verification not required) <br /> Property Owner's Name: `fipW,t o Dov‘vt ttAviai) tc�f fs , <br /> Proposed Driveway Location: CIO C(rte /v.e_ <br /> 51-o ur:4-\firn tiO I <br /> Driveway will provide access to: ❑ US/Co. Hwy Permit# ❑ Town Rd. Private Rd. <br /> Does property owner own proposed driveway road frontage? 64 yes ❑ no (If no, attach copy of easement.) <br /> • <br /> Bldg.Site yerification 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 /> ❑ 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 /> - I <br /> Signature of Applicant Date <br /> Public,Works,Foreman Initial Construction Approval Date Permit Issued Permit f ee, <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 />