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1 <br /> DATE: Town of Springfield Fee: <br /> Driveway Permit Ck. #: <br /> Name & Address of Applicant: Driveway Location: <br /> Road Name: S)0, ,,V„ t). 1r 5 4 , L p-t. <br /> (N/S/E/W) side <br /> Feet (N/S/E/W) of <br /> Phone: Section Lot# J 4x, <br /> Subdivision fl it ty , et- P. a <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 /> Culvert (made of corrugated metal), with approved end walls, if required <br /> Size: Ai ■ ,4 Iv ) �,, ` Y', .s I ✓r <br /> Signed certification that applicant agrees to abide by town ordinance <br /> Applicants Signature G Date: <br /> / t <br /> Permit Granted By: ( P/[- Date: .1 //// l Lc <br /> (Town of Springfield Designee) <br /> (White copy- Town, Yellow - Applicant, Pink- Dane County Zoning) <br />