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44''-tki+s*+.w 4 <br /> TOWN OF DUNN PARCEL #: 28-0610-O9/ 4 -S <br /> DRIVEWAY CONSTRUCTION PERMIT APPLICATION PERMIT #: <br /> SECTION 1 -SITE VERIFICATION <br /> Applicant Name• 6//1V 6,3 k MLt) P-0(al) - /V SHEt_7 Date: <br /> Address: <br /> gc2C J 64,P(' t` . k`► Lx' 1: /2 1} r-(i t)b5 7bh) Phone#: 5/ 6.2.23 <br /> Purpose: rResidential ❑ Field Road Access ❑ Other <br /> (Bldg. site verification not required) <br /> Property Owner's Name: L)O it & Ii 4 k• 7 0 N <br /> Proposed Driveway Location: 91 6/i/2 4 •.. (2-A f ft-) (a L7 <br /> Driveway will provide access to: ❑ US/Co. Hwy Permit# Xerown Rd. El Private Rd. <br /> Does property owner own proposed driveway road frontage? ❑ yes ❑ no (If no, attach copy of easement.) <br /> Bldg.Site Verification Date Comments <br /> `. . • \.\ 14,1- ;1:1 t I r, # <br /> SECTION 2 -SUBMITTAL REQUIREMENTS& CONSTRUCTION COMMENCEMENT APPROVAL <br /> Driveway Construction Permit Application must include the following checked information: <br /> Diagram Showing: Other: <br /> El Property slopes. g Copy of any required Dane Co. erosion control plan. <br /> ❑ Driveway slope. Other ,• c r f <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 /> ❑ Drainage culvert, ft. length, in. diameter. <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 Appl cant Date <br /> Public Works.Forreman Initial Construction Approval D{atfe 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 />