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Driveway Permit Fee: $50 <br /> Town of Sun Prairie Road Damage Escrow: $1500. <br /> 5556 Twin lane Road <br /> Marshall,WI 53559 Location: Q or 'III / 4 VA n.)014+1 1/4 U Ell <br /> IG2A LA-3-)b <br /> CY1,0 1/4 of i1,3 1/4,Sec. 1Z <br /> Application to Permit to Construct a Driveway <br /> (Access from private property to a town road) <br /> REQUEST BY APPLICANT <br /> Name PILEA IEQ. TE.tmki, ..r---S Fe0 KAVAA A Li 6/# <br /> Address (O2 i G 14 Le. , Ai-e_ I I )tttPt- ' i. 7- <br /> Office phone TO n . ��"I0 Local phone: Fax: <br /> Plans Prepared by Copy Enclosed Yes No <br /> Location of Proposed North,Soutl E8st west Side of GpA t, > 7Road <br /> Access: <br /> Section# ( Feet/Miles from <br /> The applicant understands and agrees that the permitted work shall comply with all permit provisions and conditions <br /> listed on the reverse side hereof~any special provisions listed below or attached hereof,and any and all plans,details <br /> or notes attached hereto and made a part thereof <br /> By Title <br /> Signature of Applicant Date <br /> Permit Conditions:Completed by Public Works personnel <br /> / <br /> • Width of driveway iiil..Ji . Zi <br /> • Center of driveway from property lint: <br /> • Drainage Culvert Needed No Drainage Culvert Needed X' /rife e <br /> i2,v Pui� A S u! <br /> Size: Length: feet �'� / L� � <br /> / „Go I . 40 co S <br /> Diameter inches / Ado, �oAP <br /> All Culverts are to have ends /S �f✓e4a / &n7 <br /> All construction equipment must use this entrance to access lot.All Culverts must have ends <br /> Other <br /> Requirements (wings).Culverts are to be completely installed prior to final inspection and approval by public <br /> works personnel. <br /> No construction materials are allowed in the public roadway.Dumping of landscaping <br /> materials(mulch,stone,topsoil,etc.)on the road will cancel the return of the$1,500 escrow. <br /> Estimated Starting Date Estimated Completion Date <br /> Notify the Town Office at 837-6688 when project is completed. <br /> DRWAY Permit Procedure Rev Ai16/15 4 <br />