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DATE: ,. 1 Feef7$ , `": <br /> Ck#: <br /> TOWN OF SPRINGFIELD <br /> DRIVEWAY PERMIT <br /> Name & Address of Applicant: Driveway Location: <br /> x <br /> t ; Road Name: . <br /> (N/S/E/W) side <br /> r <br /> Phone:% ; X74_ I ; i ( ; ' i'A 3 <br /> Feet,( S/E/W) of(nearest intersecting road) <br /> t7 ek --Y'''-''',-. .t .1 '-) " * '(".,.., Section: I Lot <br /> Subdivision - (- I : i , c; <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 /> ......- -- ....fir <br /> Applicant's Signature: Date: <br /> 3 <br /> ZP, <br /> may.. <br /> ��� � Date:, - <br /> Permit Granted By: .�r ,� � r <br /> (Town of Sprin `field Designee) <br /> (White copy—Town,Yellow—Applicant, Pink—Dane County Zoning) <br />