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DATE: Town of Springfield Fee: /mot, <br /> Driveway Permit Ck. #: jj. -,7‘1_ <br /> Name & Address of Applicant: Driveway Location: <br /> 1+r i\NI( ; 1 Z , Road Name: <br /> Ct C: C ICE \ 1 �C�� <br /> C N L V C\i(-.C41 (N/S/E/W) side <br /> , <br /> ' c.(t ,--L "C''c; V' 1 x-77` C., .� i 4. <br /> `� Feet(N/S/E/W) of <br /> Phone: � - <br /> 1 <br /> �� : \5..4F Section (:„ Lot# ■ <br /> Subdivision V I\ , \ \t \C\ r- <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 /> XCulvert(made of corrugated metal), with approved end walls, if required <br /> Size: �` j , R , <br /> Signed certification that applicant agrees to abide by town ordinance <br /> Applicants Signature Date: <br /> Permit Granted By: . , 4. Date: /‘ <br /> (Town of Springfield Designee) <br /> (White copy- Town, Yellow-Applicant, Pink- Dane County Zoning) <br /> f <br /> i <br /> / <br />