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. <br /> 03/09/2009 MON 14: 36 FAX 608 767 3015 TOWN OF BERRY <br /> 0001/001 <br /> 10/07/2008 TUE 11:16 FAX 608 767 3015 TOWN OF BERRY <br /> 0002/002 <br /> doo8-13 <br /> • <br /> DRIVEWAY CONSTRUCTION PERMIT APPLICATION <br /> TOWN OF BERRY--DANE COUNTY,WISCONSIN <br /> Applicant: Name: G2la•c. gOtirsStel.- <br /> i <br /> Current Mailing Address: F. 04, o X 9 ci <br /> City, State,ZIP: Gass PC-04144s WI ..5-b sz,e <br /> Phone Number: 7re-22.9 / Email: sraessIALrco.ztlass eraridsoh3.coµ <br /> Specific Site Location I Nearby Roads:_ W 4 c a& u p i <br /> • <br /> Parcel#: C 5M. I (9 2% '� T <br /> My'signature( Y'si$ re below indicates that: • <br /> I have received a copy of the Driveway Ordinance,the Applications Guide and.Independent <br /> Inspection's building packet,and that <br /> I have attached the information as requested for driveway permits in 2a to 2h in the Driveway Permit <br /> section of the Applications Guide,and that Y <br /> I agreeto construct the driveway in accordance with Town of Berry Driveway Permit Ordinance <br /> 42003-1 and to follow the plans and other documents as approved by the town board which become part of this <br /> permit, and that <br /> I have paid the application fee of$ r' °' C a, pceva;.s a <br /> I have td the town'Cleerk/Treasurer, and that <br /> hereby give permission to the Town Board and/or their representative which could be the Plan <br /> Commission or other inspector authorized by the town board to enter the property in order to evaluate the site of <br /> the proposed driveway and to verify compliance with and/or to enforce the Driveway Ordinance. <br /> Application.Signature: 7 2,0.4 1.4,•-4 . Date: ./ca / /'/ / c'4' <br /> Board decision: Approve V D e n y Date /) / r 7 / 'S <br /> Culvert required in right-of-way Yes No ✓ Size <br /> 2XLs-k•trt c 34# xyd <br /> Engineering Plan required? Yes No v/ ?.e e . \c).<.,s <br /> ' Additional Requirements? Yes V if yes see attached requirements No <br /> See 1,-,•,,,..ke5 p • <br /> Driveway construction must begin by Date l / 17 / 09 <br /> N o.t emb t�t,a� <br /> Driveway Permit expiration . Date I 1 / 1 _7 / J Lj <br /> • <br /> . Amount of cash bo requi d: / . Any cash bond required must be provided to the Town <br /> Clerk/Treasurer befo the p ' is issued <br /> Chair Signature: p, \A. ---~—� <br /> Date / / I /7 / ljg <br /> Permit issued by: CI Signature ,' • Kam.. D a t e /' / (7 / OP <br /> Permit is not valid tint Si_ :,,•b t e Applicant,.Town Chair and Town Clerk • <br /> Final inspection approval by: Signature in <br /> Date / / <br /> Cash Bond returned$ with interest$ Date / <br /> r <br /> • <br /> Original Copy—Office Files Copy-Applicant <br /> • <br />