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DATE: ;g'-j(-J' Town of Springfield Fee: <br /> Driveway Permit Ck. #: 6 0 <br /> Name &Address of Applicant: Driveway Location: <br /> ? _ g ag/1 1 2oame: /f f <br /> (N/S/E/W) side <br /> Feet(N/S/E/W) of <br /> Phone: 1, %- % !/;: ter.- Section <br /> � (- Lot# /E <br /> Subdivision zt,, �,; , t.__ J/ <br /> CONDITIONS: <br /> For access 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: �is <br /> " �D <br /> Signed certification that applicant agrees to abide by town ordinance <br /> Applicants Signature ..../ r' Date: <br /> Permit Granted By: ,� Date: <br /> (Town of Springfield Designee) <br /> (White copy- Town, Yellow - Applicant, Pink - Dane County Zoning) <br />