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TOWN OF DUNN PARCEL #: 28-0610- /t- '," <br /> DR VEWAY CONSTRUCTION PERMIT APPLICATION PERMIT #: ,t'6% Z„ <br /> SECTION 1-SITE VERIFICATION <br /> Applicant Name: _` ,k k .c -: i►z t <br /> i �, ,� `�� ; h ��._ Date: � (r€ ;� "2 <= ?-J- <br /> , <br /> .� <br /> Address: ') ,1 ,,, ;AO j� e,. ic'r • Phone#: r-( ; "1 :).' r i\ <br /> Purpose: Residential ❑ Field Road Access ❑ Other <br /> (Bldg.site verification not required) <br /> Property Owner's Name: L (l vvi(.;,',c `' t ,i, I.,,-t. V..-_ <br /> Proposed Driveway Location: 1"1 (A <br /> k -c, .-�'\r�.,.•. ,!_�,1-, <br /> 1 <br /> Driveway will provide access to: ❑ US/Co. Hwy Permit# XTown Rd. ❑ Private Rd. <br /> Does property owner own proposed driveway road frontage?, yes ❑ no (If no,attach copy of easement.) <br /> Milt-Site, vetificatit i tl91Ri d®9h l <br /> SECTION 2 - UBMITTAL 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. <br /> ❑ Length,width&radius of driveway curves. <br /> ❑ Driveway cross section showing depth&fill material. <br /> ❑ Drainage culvert, 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 /> accura nd does hereby agree to construct the described work in accordance with the plans and specifications filed. <br /> Signature of Applicant Date <br /> Pitak4,ft 0, �. .t i, ,. p . .. � d� ' P� <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 />