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DATE: /CI, 1 Town of Spri gfield Fee: /5(). cu <br /> ' Driveway Per it Ck. #: 5 3/ <br /> Name& Address of Applicant: Driveway Location: <br /> e Road Name: <br /> (N/S/E/W) side <br /> f f i ✓r 1 (..� J ( I <br /> Feet(N/S/E/W) of <br /> Phone: (- F ,,1-.�j _ 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 /> 1 <br /> Driveway Cons i ction Plan <br /> Erosion control p:rmit if needed <br /> Culvert(made of orrugated metal),with approved end walls, if required <br /> Size: // I <br /> Signed certification that applicant agrees to abide by town ordinance <br /> Applicants Signature c::_ , t�r Date: <br /> Permit Granted By: ./Y Date: 1/7/I i ,S <br /> (Town of Springfield Designee) <br /> (White copy- Town, Yellow-Applicant, Pink - Dane County Zoning) <br />