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APR-5-2000 08:10A FROM:NATIVE ENGINEERING I 6088504334 TO:8463963 P:1/1 <br /> - DRIVEWAY ! CULVERT PEHMI I APPLICATION <br /> TOWN OF BERRY <br /> . DANE COUNTY, WISCONSIN . . <br /> . <br /> -!' • • • • <br /> Applicant: <br /> Name: • Jiff '` 'RENEE Mst <br /> Current Mailing Address: ,?1 oz PATT I . AP- #7 . <br /> City, State, 'LIP' MInDLETo//j Ni <-3c Z <br /> Phone Number (Pi 1 1Z <br /> ,F <br /> . <br /> T,.. Site Location: ATTACH SKETCH OF PROPOSED DRIVEWAY!CULVERT LOCATION • <br /> . <br /> Address/location of site: 6tt/Cl- rE Ate' FL. <br /> City, State,ZIP (JQJ p 1764/4/J'` or cl�' <br /> CULVERT REQUIRED IN RIGHT-OF-WAY: Yes, No ?O)( I,?e <br /> The Town of Berry Ordinance pertaining to Driveways/culverts was provided to me. I have read and understand <br /> the ordinance and agree to comply when constructing the above described driveway/culvert. A performance ' <br /> (cash)Bond will be provided to the Town Clerk/Treasurer prior to Issuance of the permit. <br /> I will cal!the Town Chairperson when the rough graded driveway is completed for approval inspection. <br /> Amount of performance (cash) bond required: $ 4?co, bo <br /> Applicant Signature: a .� /g /1:‘ pate• Z2 <br /> • <br /> ' Board decision: / <br /> Approve V Deny 3 <br /> Y Date; /� UD <br /> Chairperson Signature: ' • 4,p <,,� _.f.,e ,,,�- ' Date:mil U , <br /> Permit issued by: <br /> Clerk Signature: , Q Afd Date:2 i 2 j <br /> This permit is not valid unless signed by the Applicant,Town Chairperson,and Town Clerk. ' <br /> NIP r P P P V t t V • 1 I I I V • 1 • 1 • 1 • 1 1 f • • • • • • , • • <br /> Inspection Approval by: <br /> Signature: Date;,,,,,1 / <br /> Performance.(cash) Bond returned: $ Date: <br />!. • • <br /> Original Copy-clerk Copy-chairperson I town files Copy-applicant <br /> revised 4/19!99 <br /> L •• <br /> • <br /> • <br />