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TOWN OF DANE DRIVEWAY PERMIT <br /> Date `fiMi Fee tom, acs Ck# (1145 <br /> Name and Address of Applicant: Driveway Location: <br /> Vernon 4. Darree, 5' L4 b1 j U Road Name tSif11C' Rol • .._. <br /> -730 3 6 f,- , Gig o2_.V 1 --073 <br /> �J (N/S/E/W) side <br /> Lodi V■) 53555 <br /> Feet (N/S/E/W)of <br /> Phone (pc- 35r-7&)`+ Section: 7 'f'gT 5 ,s--‘,4 <br /> 5? c tb ,v /1%. GofLT'`F� <br /> CONDITIONS: ? � ; -i-`` �tivf ©* 1� hT <br /> For access from private property to a Town road the permitte driveway must meet all requirements Per <br /> Town Ordinance# 1002. <br /> Signed certification that the applicant agrees to read and abide by the Town Ordinance. <br /> Applicants Signature /� L /4„ Date 1 V(67 <br /> r" i <br /> Permit Granted By �?7/f/. %`�`' Date /0A, <br />