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DRIVEWAY CONS i RUCTION PERMIT APPLICATION PERMIT #: /O Co,3 <br /> SECTION 1-SITE VERIFICATION ; 1 5a e m k k ycl boa C'C'%1 i./�,->7e.-,7 dit Z 0Jy, <br /> �licant Name: ,1-. .? 41Al y Date: e 3 271 r ' <br /> c <br /> Address: 4�,f�-' /r i 4)d, .S J 6*1 wPhone#: Zee 8'' 75/` �' <br /> Purpose: yResidential 0 Field Road Access ❑Other / 7/Co <br /> (Bldg.site verification not required) <br /> Property Owner's Name: ,,P 4 Md #7 , M,`�/::7 <br /> Proposed Driveway Location: .6 r.V ew7 -1-.0 ,5 74-ar a; ;-s yfir& <br /> Driveway will provide access to: ❑US/Co. Hwy Permit# Town Rd. ❑ Private Rd. <br /> Does property owner own proposed driveway road frontage?'yes ❑ no (l no,attach copy of easement.) <br /> • Bldg.Site Verification 43 Date, 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 ,, jf <br /> 0 Driveway turnaround. (,t'/Aid [Q/7,Q.S Gi.1 ,/'aai. <br /> ❑ Location&structure of retaining walls. <br /> 0 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 /> accurate and does hereby agree,to construct the described work in accordance with the plans and specifications filed. <br /> -77 3► --iIl3 <br /> 1 Signature of Appliant Date <br /> Public Works:F initial Date Permit issued Permit Fee <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 p 0:ci-t <br /> "i•Y L. .e.../- -il...i , ,..- i1"' /1-)1M.T :i"jc1_53' — e-on�,c 1.4,JiL1.. V kaia. 33?2/ <br />