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ji <br /> { <br /> { <br /> Town of Burke <br /> Driveway Permit Application <br /> (Access from private property to a town road) <br /> NAME OF APPLICANT: . ,. „ s p.. ■ <br /> *AI-- <br /> ADDRESS OF APPLICANT: l 4 p C. t5 <br /> tM A6t4g !,1.5t X35"z 2 <br /> PHONE NUMBER: ( �� . z z <br /> PROPERTY OWNER: iz,`KA G erg" <br /> LOCATION OF PROPOSED ACCESS: <br /> Lot# 4 Subdivision 6vi-t-ozXe5 ;4136 Ce___ Street xpz✓!tier 17s.. <br /> North, South, East, 411 0) ide of 0m5-rn t.oc.... . 1- £ . Road <br /> Town of Burke, Dane County,Wisconsin <br /> { <br /> ************************************************************************* <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 ameter is 18 inch arch with end walls (wings <br /> ' { } No drainage culvert needed <br /> } 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: f/7//5 <br /> scant signature <br /> Permit granted: h jC, Date: 7/20/ <br /> (Town al/Desi ee Si ature <br />