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1 <br /> Name of Applicant VIl � � <br /> Q4 ?o! <br /> PART II: (Permit) <br /> 1. Town Board denied driveway permit. Date: <br /> ii--approved permit. <br /> Date: 5 i C� <br /> 2. Engineer's plan is not required. <br /> his required. <br /> Date of approval by Town Board -s q/ // <br /> 3. A culvert at the ditch line where the driveway meets the public <br /> road <br /> is is required. <br /> is not required. ' •67 . ,�� 47?;///,/ ; <br /> Signature of To oard Chairperson 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 />