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• <br /> '4 • <br /> • <br /> PAGE 2 <br /> Name of applicant of Driveway Culvert Application: <br /> ail- sz Aae WGTr,el- <br /> PART II : (Permit) <br /> 1 . Town Board denied driveway permit. Date: <br /> /approved permit. Date: /d—AC a i <br /> 2 . Engineers ' Plan . ,/ <br /> is not required. <br /> is required. <br /> Date of approval by Town Board / /1- 9 g <br /> 3 . A culvert at the ditch line where the driveway meets the public <br /> road , / <br /> aild A -" 1 (/.e(r'er /j44 V is required. <br /> ii not required. <br /> /./ Culvert rt with wings required at each end <br /> of the culvert. <br /> /e--/ - Q <br /> Signature of Town Board Chairperson Date 9 <br /> PART III : (Inspection of Completed Driveway) <br /> Driveway is in accordance with plans approved by the Town <br /> Board. <br /> Driveway is not acceptable. <br /> Owner will make required improvements by <br /> Comments : <br /> Signature of Town Chairperson <br /> Date <br /> NOTE: This form with Parts I and II completed must be presented <br /> to the Dane County Zoning and Natural Resources Committee <br /> before 'the County will issue any required building <br /> permits . <br />