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6PAe ( csz-9 <br /> Kuyt <br /> Town of Burke Liv f 2 <br /> Driveway Permit Application <br /> (Access from private property to a town road) <br /> NAME OF APPLICANtT: Ad-IAA/1A WIMCI W S �( ctcJ LL C_ <br /> ADDRESS OF APPLICANT: 7-10 7 C CAA '�( •eo E <br /> PHONE NUMBER: 6� ~ S= c7o 64-/ <br /> PROPERTY OWNER: G(kry/On /C0,4,1i-e^ /-4) eirie7 r <br /> LOCATION OF PROPOSED ACCESS' <br /> Lot 7 Subdivision !/ .9eic [Tec Stie l (,/60 Gc( <br /> North South."East. West side of Road <br /> Town of Burke. Dan° County. Wisconsin <br /> PEr'dvii_ .JNDTTI_)?\: <br /> Ti-c: C° conlnieted n TOWS - erSonne' ; <br /> 1.yL feeT 1-,yid re.,auesT va-_ianc :! fee; <br /> C1;ainan <br /> a ian _ ron1 si : n::°de:. <br /> Di--;ye wac �! lvtLi�� st iZc A ex. r low.v <br /> ��t] RnQuiremnnts: <br /> i' construction equlo11]°Ill rnus: List- this entrance to access lot. CuJver:s am a: <7° <br /> collloietei: installed Ur10?- t' Iinai inspectioI; and 10,0rovai ilv 111LT1?wflv" personnel. <br /> el. <br /> aci;_nolwdedu° rec°ip: of attached :-_>rdinance and agree to ioliov, all terms. <br /> 7 Date: /O'4' /S <br /> Anni .,an: sia T_I.2�u,re. <br /> Pf.ITM1. granted: 2.L Date: /o <br /> :Tow!)'lfficiaUG sienee�i ratur <br />