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TOWN OF DANE DRIVEWAY PERMIT <br /> Date 0 511 t . C"*/ Fee 1/5-6) Ck# <br /> Name and Address of Applicant: Driveway Location: <br /> 77: r jrf 4"' Jj<4,0 z i Road Name Ld V%r7 • --.. <br /> I NJ j f U k1.� 4 0 F 1..dr <br /> (N/S/E/W) side <br /> Feet(N/S/E/W)of <br /> Phone 6/C 5 - 3 3 Lp S Section: 3 1 <br /> CONDITIONS: <br /> For access from private property to a Town road the permitted 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 4�IL fc Date (2 8 I7 <br /> Pp g <br /> Permit Granted By Vtip Z Date 6 �I�� <br />