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@opv n5 <br /> 2o16 <br /> TQWN OF VtKUNA <br /> TOWN OF VERONA <br /> • DRIVEWAY CONSTRUCTION PERMIT APPLICATION • <br /> (Driveway Ordinance#2009-02B) <br /> icati a o `0 Va, i e e iv'ct on er t cannot�b „ o s r:t3 a' s� cr ated „ <br /> Cell d s es•a * 9��s z s ® �® <br /> ��� ry DTI Atha� S��n��E;� <br /> w` k <br /> �be a a';a dnvewa g s� C a k a ea° o e g ocesng4T s ti "� -� "� ' -' ,. r l <br /> ,-. e ,..� � ���j � �m -�� , r z c3s�c.� � �,. <br /> ,.r mp ed C3 ®D$N R 8 rf o ,� bed'=Jr�-�e 9 th e' 0 be C asSOCTL hs <br /> 10 Escrow <br /> s�% ;bl Has Pr: vi r. d......''"_ /1,t-o,,j7 vsC r..q 0*;.r aW.. -a:-.a...... <br /> Note: A building permit may not be issued for any parcel without an approved Town of Verona driveway <br /> construction permit. <br /> REQUIRED INFORMATION <br /> Landowner: N .�h;e l 0. Q r N.1.7 Applicant/Agent: S c i%e <br /> Address: 50 6 Lone P;ne Info. IJtrons, wr Address: <br /> Phone:(OR-R`11-1to6 Cell: (o08-3`I7- 2503 Phone: Cell: <br /> Email:A b r A zy(/ -1-c1 f. net Email: <br /> Mailing Address for Completed Permits: Name: Al fL ar i el D. Q ra zy <br /> Address: 59‘ Lone P;he 1/7 City: Vtfone., State Vi-t Zip 5359) <br /> Parcel#062-0608- 2 L.3- 9160'0 Road to be Accessed by Driveway: R.49e Tr k:I <br /> Legal Description: <br /> Type of Proposed U. I�� *CHANGE of Use -RELOCATE- IMPROVEMENT or <br /> C I V RT REPLACEMENT (circle one(1)): <br /> (*Change of Use applies should a Dane County Conditional Use Permit be required.) <br /> O Agriculture$1000.00 O Field Road$1000.00 ,1 Residential$1000.00 <br /> O Commercial$1500.00 O Industrial$1500.00 O Temporary/Access Drive$500.00 <br /> O Improvement or Culvert Replacement$300.00 <br /> Driveway Length&Width: �°Z x 420 Feet Existing Drive: 0 N <br /> (proposed) <br /> Existing Culvert: Y <br /> If yes,approx.Diameter (INCHES) <br /> Date of Proposed Driveway Construction: L,�, c_,, 4-11/ <br /> 1 <br />