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DATE: Town of Springfield Fee: / g� <br /> Driveway Permit Ck. #: / <br /> Name & Address of Applicant: Driveway Location: <br /> aJ- Si,7aS..en Road Name: 6/0,-) /5Jda�r'j(2-k. <br /> 9 <br /> 70402 Ave <br /> (N/S/E/W) side <br /> /dd i Id/ <br /> Feet(N/S/E/W) of <br /> Phone( c )4 d' Section Lot# 2 7 <br /> Subdivision 4, 141 ,,, .1 (J,a Ii <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:(II, l .Y YQ li r ' /i <br /> Signed certification that applicant agrees to abide by town ordinance <br /> Applicants Signature JL, , rid ii� �i�•� Date: j `? ,//;(, <br /> ir <br /> Permit Granted By: L, .-'7j / Date: r/4 <br /> (Town of Springfield Designee) <br /> (White copy- Town, Yellow-Applicant, Pink-Dane County Zoning) <br />