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0 <br /> Town of Burke <br /> Driveway Permit Application <br /> (Access from private property to a town road) <br /> NAME OF APPLICANT: A 11 (5-c.4,/0 SfLS D4•-) " CI(SA r2.4.1 14%#'//3;1,6 Cva.p <br /> ADDRESS OF APPLICANT: )C4 C) PA p I ; • P1 o, x Q. 02-2-07 <br /> v-a.0,4 1 L.); 3S <br /> PHONE NUMBER: G CPS `.(-1' a —q--)00 C 60a-2]2-72._1 <br /> PROPERTY OWNER: Lt. 2,.. <br /> LOCATION OF PROPOSED ACCESS: <br /> J bo <br /> Lot#� Subdivision �i Street 101.--644 .1 IQ, <br /> North, South,East,West side of Iv Of-41,N Road <br /> Town of Burke,Dane County,Wisconsin <br /> ************************************************************************* <br /> PERMIT CONDITIONS <br /> (To be completed by Town Personnel) <br /> Driveway is 24 feet wide. I request a variance of feet <br /> All culverts are to be 24 feet long. Diameter is 18 inch arch with end walls (wings). <br /> {t o drainage culvert needed <br /> { } Variance from size needed. <br /> Other Requirements: <br /> All construction equip •nt 1 ust use this entrance to access lot. Culverts are to be <br /> completely i• tailed prior o fin:i inspection and approval by highway personnel. <br /> I kno , ige re ipt of tta ed Ordinance and agree to follow all terms. <br /> Date: 4 <br /> Appli t signatti e /.//j-- <br /> Permit granted i<1.4/1..... Date: Zo �!e _.. J <br /> (town♦fficiaVlacstencc Signature) � <br />