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DATE: C-, -4 7,1 ii(5-- Fee: I
<br /> Ck#: 4°
<br /> TOWN OF SPRINGFIELD
<br /> DRIVEWAY PERMIT
<br /> Name & Address of Applicant: Driveway Location:
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<br /> Road Name: / ' ', * , , ,,, ( 1 , ' - .f.`7 -01 7: /
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<br /> ,-- , „... , (N/S/E/W) side
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<br /> Phone
<br /> 1 / , Feet (N/S/E/W) of(nearest intersecting road)
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<br /> r:,, 1. Section. Lot# / /
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<br /> Subdivision /I ., f -., - 1 ii
<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 /> / /7) . .,,,,,
<br /> Applicant's Signat ' -,,,-- , , Date
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<br /> lee
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<br /> Permit Granted B1: i ii" i
<br /> Date: 1, 1:,? 1)
<br /> , , 3
<br /> (Ti own of Springfield Designee)
<br /> (White copy-Town,Yellow-Applicant, Pink-Dane County Zoning)
<br />
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