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DATE: <br /> � � �� Fee: ;` <br /> Ck#: _ 4A r <br /> TOWN OF SPRINGFIELD =8 <br /> DRIVEWAY PERMIT <br /> Name & Address of Applicant: Driveway Location: <br /> Road Name: - r <br /> ( N/S/E/W) side <br /> Phone: <br /> Feet (N/S/E/W) of(nearest intersecting road) <br /> r d <br /> { Section: 3 Lot# <br /> Subdivision <br /> CONDITIONS <br /> For access from private property to a town road the permitted driveway must meet all <br /> requirements per Town Ordinances 4.18. The applicant shall complete the Driveway Permit <br /> Checklist. <br /> By signing below, the applicant agrees to abide by the Town Ordinance and any other <br /> requirements imposed by Dane County and/or the State of Wisconsin. <br /> Applicant's Signature: Date: <br /> :: �` 1,f�;..- Date: � i ,�;�� A." <br /> Permit Granted By: . <br /> (Town of Springfield Designee) <br /> (White copy—Town,Yellow—Applicant, Pink—Dane County Zoning) <br />