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DATE: 71V-45- Town of Springfield Fee: 0 <br /> Driveway Permit Ck. #: <br /> Name& Address of Applicant: Driveway Location: <br /> 604 o r/i 7 /e k/ Road Name: Ape as/' <br /> 4,157 Cg ? tdes-i- <br /> (N/S/E/W) side <br /> bleloPi WI 555Z� <br /> Feet(N/S/E/W) of <br /> Phone: ba'Syq` 7kY 7 Pa t lo4 00g"fly'of 9 mss' <br /> Subdivision <br /> CONDITIONS: <br /> For a ccess from private property to a town road the permitted driveway must meet all <br /> requirements per Town Ordinance 4.18 which includes the following: <br /> -�� Driveway Construction Plan <br /> ~ Erosion control permit if needed <br /> Culvert (made of corrugated metal), with approved end walls, if required <br /> Size: ,z)I,4/ 1 <br /> Y Signed certification that applicant agrees to abide by town ordinance <br /> Applicants Signature A o Date: 7 ` 23—/3-- <br /> Permit Granted By: �gd' Date: 7 4 ) hr--- <br /> (Town Df Springfield Designee) <br /> (White copy- Town, Yellow -Applicant, Pink- Dane County Zoning) <br />