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DATE: >0 "°11-4°, Town of Springfield rin field Fee: 15C'-oo <br /> Driveway Permit ck.#: <br /> Name & Address of Applicant: Driveway Location: <br /> Road Name: U t w,y�� F`�1 i)d. TA,') <br /> f�a;K°°'i'tacT 1. r: y::4 a <br /> (N/S/E/W) side <br /> Feet (N/S/E/W) of <br /> Phone: 1. , 111 Section: Lot # 1 2. <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 /> Culvert (made of corrugated-metal),with approved end walls, if required <br /> r r <br /> Size: Af' X .j, <br /> Signed certification that applicant agrees to abide by town <br /> ordinance <br /> Applicants Signature `� '�' �. Date: O ;- U <br /> ■ <br /> Permit Granted By: "417 0-O; r Date: e s- <br /> (Town of Springfield Designee) <br /> (White copy - Town, Yellow - Applicant, Pink - Dane County Zoning) <br />