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vJ <br /> DATE:73-/3 Town of Springfield Fee: /5 <br /> Driveway Permit Ck. #: 5-32 "3 <br /> Name &Address of Applicant: Driveway Location: <br /> Road Name: � �tlo/I_5' ,e,j <br /> (N/S/E/W) side <br /> Feet(N/S/E/W) of <br /> Phone: j"/�— ,f'22- Section Lot# <br /> Subdivision <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 /> Ip ) Pp q <br /> Size: I2. IV Iy / <br /> Signed certification that applicant agrees to abide by town ordinance <br /> Applicants Signature `-�"""7 / l Date: <br /> Permit Granted By: Date: _EA)/ <br /> (Town of Springfield Designee) <br /> (White copy- Town, Yellow-Applicant, Pink- Dane County Zoning) <br />