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Ichif <br /> (bog) may--75'37 t l !a1 <br /> 61, &As) till 51- Z f3q <br /> Town of Burke <br /> Driveway Permit Application <br /> (Access from private property to a town road) <br /> NAME OF APPLICANT: Dc"-.4_) <br /> ADDRESS OF APPLICANT: / 5 )o j4-AjG.c_L <br /> , PHONE NUMBER: jai-Co r?1f- - <br /> PROPERTY OWNER 1'n iCel .0 L I)4,11 <br /> LOCATION OF PROPOSED ACCESS: <br /> Lot 0.2 Subdivision /to IM 4*-) Acres street Rex/4 A n lent <br /> North.South,East iiglide of le.0,4-1-ik4t" taQ. <br /> Town of Burke,Dane County, Wisconsin <br /> ******************************************************T T**************TT T <br /> PERMIT CONDITIONS <br /> (To be completed by Town Personnel) <br /> Driveway�de. I request a variance of feet <br /> All culverts are to be 24 feet long. Diameter is 18 inch arch with (win=s)_ <br /> { } No drainage culvert needed <br /> } 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 ac>mowledee receipt of attached Ordinance and agree to follow all terms. <br /> Date: a -J 0 - ZC ite2 <br /> Applicant signature <br /> Permit Granted: Date: Felb i D 2I Ce <br /> (Town Signature, <br />