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DATE: 121(2-/) Town of Springfield Fee: /v c <br /> Driveway Permit Ck. #: y oot/S <br /> Name&Address of Applicant: Driveway Location: <br /> AcilfA ev f) Mc Road Name: 7 41/7 Peak <br /> 33lf . 5T <br /> (N/S/E/W) side <br /> ke. /1A- ter2 Lc)/ <br /> Feet(N/S/E/W) of <br /> d <br /> Phone: . ' d--6�� Section Lot# <br /> Subdivision r S <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 /> V Culvert (made of corrugated metal),), wyth approved end walls, if required <br /> Size: f1'J )70,/ Afilbff ) ;i f 1 / 1'// <br /> Signed certification that applicant agrees to abide by town ordinance <br /> Applicants Signatur ile Date: /07-1/0 <br /> Permit Granted By: f Date: )o h/s)--- <br /> (Town of Springfield Designee) <br /> (White copy-Town, Yellow-Applicant, Pink-Dane County Zoning) <br />