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n <br /> t <br /> DATE:,-Z 745 Town of Springfield Fee: <br /> Driveway Permit Ck. #: <br /> Name &Address of Applicant: Driveway Location: <br /> ��L it._ � Road Name: (r,��s1 <br /> (N/S/E/W) side <br /> it <br /> Feet(N/S/E/W) of <br /> Phone: /(`r J� �`` Section Lot# <br /> Subdivision / ; (1/ ; <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:71 I1 'J Y Q 4r(. 1 44 <br /> Signed certification that applicant agrees to abide by town ordinance <br /> Applicants Signature Date: <br /> r f <br /> Permit Granted By:/,1 f.: -Mr= Date: '1 J 2 f r <br /> (Town of Springfield Designee) � <br /> (White copy- Town, Yellow- Applicant, Pink - Dane County Zoning) <br />