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Town of Burke <br /> Driveway Permit Application <br /> (Access from private property to a town road) <br /> NAME OF APPLICANT: 3i 5')cam,—'r.\ <br /> ADDRESS OF APPLICANT: Z7, ft cwex Ti 1 <br /> PHONE NUMBER: t(DS—33 S —(S3-6 O <br /> PROPERTY OWNER: ,h Yl -0('/ L (,c_.1 <br /> LOCATION OF PROPOSED ACCESS: 1 /t� <br /> Lot it Z Subdivision ! Y //�-�,- Street k15)'f'S7 1 k �r <br /> North. South, East. West side of 1 c e,5 c Road <br /> Town of Burke. Dane County, Wisconsin <br /> :*******************>, * : <*************************y *****************;***T <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 (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 ackno ' edge receipt of attached Ordinance and agree to follow all terms. <br /> Id 1r/ Date: -4/ 1-//6 <br /> Apph r .nt signature <br /> Permit granted: /4W7 Date: rLl2c' <br /> (Town Official/Designee Signature) <br />