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o <br /> / c �) <br /> DATE: Town of Springfield Fee: / <br /> Driveway Permit Ck. #: / <br /> Name & Address of Applicant: Driveway Location: <br /> T I 14' 1`E t , �. Road Name: f i A:i 1-1 - ; r) n t <br /> Q A z <br /> (N/S/E/W) side <br /> /1 1 \s Di:‘-4--10,, i.3 •„ -5-Y4-0 ) 04 --, - 41, <br /> Feet(I $ E/W) of <br /> Phone: 6 ce 5- 2g -4/ 7 Section Lot# <br /> Subdivision <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 /> VCulvert(made of corrugated metal), with approved end walls, if required <br /> Size:/!') i 4 � t V / 1)1'4 11 4-d <br /> _ -d certification that applicant agrees to abide by town ordinance <br /> / 1� <br /> Applicants Signature !� ' %- . —. Date: `7 - A <br /> ,_, 2,, ,_.- - ) i ,d - i_i / 7 ..Permit Granted B JJ 17-4( /..... <br /> y y / Date: 7/t �i f <br /> (Town of Springfield Designee) <br /> (White copy- Town, Yellow-Applicant, Pink- Dane County Zoning) <br /> • <br />