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game of Applicant <br /> • 1(1 Ore I e. L E�✓` <br /> p <br /> PART IX: (Permit) <br /> 1. Town Board denied driveway .1�� � /� 1) <br /> y permit. Date: <br /> V approved permit. Date: 0/lb <br /> 2. Engineer's plan iL is not required. <br /> is required. <br /> Date of approval by Town Board / /4'/f'7 <br /> 3. A culvert at the ditch line where the driveway meets the public <br /> road .� . . <br /> is required. <br /> is not required. ' <br /> r) /o/q/i <br /> Signature of Town Boar airperson Date <br /> PART ills (Inspection of 'Completed Driveway) <br /> Driveway is in accordance with plans approved by the Town Board <br /> • <br /> Driveway: is not acceptable. <br /> owner will make required improvements by <br /> Comments <br /> • <br /> • <br /> Signature of Town Chairperson Date <br /> NOTE: This form fully completed must be presented to the Dane County <br /> Zoning and Natural Resources Committee before the County will <br /> issue any required building permits. <br />