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TOWN of DUNN PARCEL #: 28-0610-a3 y- ,s <br /> A/O7 '• <br /> DRIVEWAY CONSTRUCTION PERMIT APPLICATION PERMIT #: L53 <br /> SECTION 1- SITE VERIFICATION <br /> A licant Name: � ,t, ,j C1 �'c'J <br /> pp i}�(LE:a t �-;.� G Date: <br /> Address: t� . ) 1�a V 1 i(7 it/, 5 .�✓ �' Phone#:-' 5/y2/1, ZO <br /> Purpose: ['Residential ❑ Field Road Access ❑ Other L.,17 2? <br /> (Bldg. site verification not required) <br /> Property Owner's Name: E � <br /> oft Iti0I us: K.! <br /> Proposed Driveway Location: ? o r I y' <br /> Driveway will provide access to: ❑ US/Co. Hwy Permit# 11"-Town Rd. ❑ Private Rd. <br /> Does property owner own proposed driveway road frontage? yes ❑ no (If no, attach copy of easement.) <br /> Bldg.Sitte 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 /> i Property slopes. ❑ Copy of any required Dane Co. erosion control plan. <br /> Driveway slope. ❑ Other <br /> ❑ Driveway turnaround. '; <br /> ❑ Location&structure of retaining walls. <br /> Nr Length,width&-r-adits•of driveway curves. <br /> El Driveway cross section showing depth& fill material. <br /> 1X Drainage culvert, ft. length, in. diameter. 2i11114-1-4, 1/ t,r`; /.�. <br /> EX-Driveway relationship to property lines, structures&roads. Center of driveway /J 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 /> • 1 ` <br /> Signature of Applicant / D. - --� <br /> Public Works Foreman Initial Construction Approval Date Permit Issued . t ; <br /> S f� <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 />