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I?wt. yes -l g 3 '> <br /> Town of Burke <br /> Driveway Permit Application <br /> (Access from private property to a town road) <br /> W <br /> NAME OF APPLICANT: (0,4 lei CA) <br /> ADDRESS OF APPLICANT: 1. x f 1 o <br /> 3 •6)a <br /> PHONE NUMBER: /4005?- - (43') I <br /> PROPERTY OWNER: U <br /> LOCATION OF PROPOSED ACCESS: n,� <br /> Lot g tip_ Subdivision Street <br /> North. South. East, West side of Road <br /> Town of Burke. Dane County. Wisconsin <br /> *****************:,.******************************************************* <br /> PERMIT CONDITIONS <br /> (To be completed by Town Personnel) <br /> Driveway ?4 i fe mi I request a variance of feet <br /> All culverts are to be 24 feet long. Diameter is 18 inch arch with en rails (wins). <br /> No drainage culvert needed <br /> I Variance from size needed. <br /> Other Requirements: <br /> All construction equipment must use this entrance to access lot. Culverts are to be <br /> completely installed prior to final inspection and approval by highway personnel. <br /> I acknowledge receipt of ajttacnhedd Ordinance and agree to follow all terms. <br /> 1) 0.L'-d:k.. Date: C1, .. )- ) �/n <br /> Applicant signatur <br /> Permit Granted: Coin- Date: <br /> — / — !4 <br /> )Ton Official/Designee Signature) <br />