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5/ Co/ 15 <br /> DATE: Fee: <br /> Ck#: <br /> TOWN OF SPRINGFIELD <br /> DRIVEWAY PERMIT <br /> Name & Address of Applicant: Driveway Location: <br /> \�1ck* \c c\ \ k'(Y\r.c Road Name: N,Cw \'\ V1 , to Rd <br /> �2B <br /> Muck\V\%\i \\e . <br /> Co Y JJ P1 C \'S , LOl 55.52Z <br /> (N/S/E/W) side <br /> Phone: ,,00d - 51 lc - LiZB <br /> Feet (N/S/E/W) of(nearest intersecting road) <br /> Section: 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 /> , ///1 r / r <br /> Applicant's Signature: Date: <br /> Permit Granted By: Date: <br /> (Town of Springfield Designee) <br /> (White copy—Town,Yellow—Applicant, Pink—Dane County Zoning) <br />