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i <br /> 1 TOWN OF DUNN PARCEL #: 28-0610- <br /> DRIVEWAY CONSTRUCTION PERMIT APPLICATION PERMIT # <br /> SECTION 1- SITE VERIFICATION <br /> Applicant Name: k. T 2 /4:-t1 t I 1 1 1_. <br /> �.CI Li <br /> Address: <br /> /rL) I ! ) /f' <� r i ;. � (= CI; <br /> t/i--t .� _ J 5 37/ Phone#: 60'� -t�s r <br /> Purpose: Ekesidential ❑ Field Road Access ❑ Other 0-- Y) <br /> N (Bldg. site verification not required) <br /> 1- <br /> Property Owner's Name: ( ' ‘,1 i t.r ( °' <br /> Proposed Driveway Location: , ,', , 3 ; - J( .. (1 a O r1 <br /> 1� ex i_; ) h o d i ►Ve tofA y <br /> Driveway will provide access to: 0 US/Co. Hwy Permit# XTown Rd. ❑ Private Rd. <br /> Does property owner own proposed driveway road frontage?, ,J yes ❑ no (I '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. 0 Copy of any required Dane Co. erosion control plan. <br /> ❑ Driveway slope. Q Other '.t/f At-,f 1. (A,.._ <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 /> _ ft. length, �' ° Y in. diameter. k4—C,-, - /A e i - u <br /> X Drainage culvert, <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 /> ' lid o anRlmtial'Construction Approval ate Permit Issued Permit Fee <br /> _ _figA..- l- .r I. <br /> ` .. '' <br /> SECTION 3 - FINAL APPRVAL <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 />