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, <br /> TOWN OF DUNN PARCEL #: 28-0610- "'W <br /> DRIVEWAY CONSTRUCTION PERMIT APPLICATION PERMIT #: X03! <br /> SECTION 1-SITE VERIFICATION ( . /J<) <br /> CCot'�s L E %a t-113 bo - 771131 Applicant Name: &E BA LI K IN(1€ . te: S--,23 -got 6 <br /> Address: a•O\ W B t oROW AY STov(,NzoN) wt 535-89 Phone#:6,0g-655-Yea i <br /> Purpose: ST,Residential ❑ Field Road Access 0 Other <br /> (Bldg. site verification not required) <br /> Property Owner's Name: GE RR LO K 1SS <br /> Proposed Driveway Location: k1vJ•( 51 .1- QyRE Sod goA 0 <br /> ;t <br /> Drivewayyil'provide access to: ❑ US/Co. Hwy Permit# Er Town Rd. ❑ Private Rd. <br /> Does property owner own proposed driveway road frontage? ❑ yes ❑ no (If no, attach copy of ea emend <br /> Bldg. Site Verification Date Comments <br /> , tom <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. / / Qom,, <br /> Ki Drainage culvert, �i,`� ft. length, / in. diameter.(N/ '`G!.b%1-r"�'- <br /> i <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 ereby 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 /> 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 /> 32J dc.,,J 572 //(7 <br />