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TOWN OF DUNN PARCEL #: 28-0610- 3(.7i2- 01673-y <br /> DRIVEWAY CONSTRUCTION PERMIT APPLICATION PERMIT #: /� <br /> SECTION 1- SITE VERIFICATION <br /> + 9- 3 - 0 $ <br /> Applicant Name: k ?.1) La L �1� (;�Gt 7 !':� Date: <br /> Address: /19 g MO( rt_t I ne.View 1)04-1 0.3 1-1 Lsoki Phone#: c'19–39 q g <br /> Purpose: esidential ❑ Field Road Access ❑ Other 37/tj <br /> (Bldg. site verification not required) <br /> ►'1 <br /> Property Owner's Name: 1<d, -c La L. 4"1 1,0 a r <br /> Proposed Driveway Location: Nex-- to -4=g4Fr. 5 . Qt m .b r'. <br /> vac° ► - " <br /> Driveway will provide access to: ❑ US/Co. Hwy Permit# XTown Rd. ❑ Private Rd. <br /> Does property owner own proposed driveway road frontage?,Nyes ❑ no (If no, attach copy of easement.) <br /> Bich Site Verif on Da 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 /> ❑ Property slopes. ❑ Copy of any required Dane Co. erosion control plan. <br /> ❑ Driveway slope. ❑ Other <br /> ❑ Driveway turnaround. <br /> ❑ Location& structure of retaining walls. [ 627 /11-)C(x %�� <br /> ❑ Length,width&radius of driveway curves. /j/- `-1 / <br /> ❑ Driveway cross section showing depth&fill material. — rr/e of%Drainage culvert, oC(/ 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 Applicant ' Date <br /> ' .blic Wo •,em = Ini Construction Approval O.:te:P- ;t Is ued Perm F <br /> �/► i. . e « - + > <br /> SECTION 3 - FINAL ' 'PROlAL <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 />