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Town of Burke <br /> Driveway Permit Application <br /> (Access from private property to a town road) <br /> NAME OF APPLICANT: nCa' - Lon°ji-64.LF-,'on <br /> ADDRESS OF APPLICANT: 6 C 6'-2 D 0907 ci c e! ►�c�a.L <br /> }or k'• ;- 53$ 6 Z <br /> PHONE NUMBER: (oCSS- 536- 1601 0641L 65-212-15") w <br /> PROPERTY OWNER: h reaw <br /> LOCATION OF PROPOSED ACCESS: <br /> c,�lo <br /> Lot 4 I Subdivision C$� 13367 f4com4*ol�'1' Street-9 <br /> 9 er• ile C, v <br /> North. South, East. West side of fac/47 e, &ie.( le/ ( 1G)e Road <br /> Town of Burke. Dane County. Wisconsin <br /> *****.******* ******************.********:;* k*****.*********************** k** <br /> PERMIT CONDITIONS <br /> (To be completed by Town Personnel) <br /> Driveway is 24 feet wide. I request a variance of feet <br /> All culverts are to be 24 feet long. Diameter is 18 inch arch with end walls (winos). <br /> No drainage culvert needed <br /> i Variance from size needed. <br /> Other Requirements: <br /> All construction equipment must use this entrance to access lot. Culverts are to be <br /> completely installed prior to final inspection and approval by highway personnel. <br /> I acknowledge receipt of attached Ordinance and agree to follow all terms. <br /> Date: /41"1, 7 le2j ael <br /> Applicant signature <br /> Permit granted: Ott. IT Date: AprTi_ ( i <br /> town Official/Designee Signature <br />