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DATE: ("///,-,7,,._ Town of Springfield Fee: ' /562 ' <br /> ' <br /> Driveway Permit Ck. #: <br /> Name & Address of Applicant: Driveway Location: <br /> r s11�t- r t�\1 ,1") 41__...- :1 t Road Name:, . 1 ` ',I i _ _ <br /> bp <br /> (N/S/E/ side <br /> 1 75-97 ; -6 <br /> ,1 1, �, _a <br /> eet /S/E/W)of <br /> f <br /> Phone:? - `/ l�" -.7? Section / Lot# - <br /> Subdivision );')11 (14- -it4 l� C <br /> fj 17- 7-1 <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: <br /> Signed certification that applicant agrees to abide by town ordinance <br /> Applicants Signature / f'. f : i ;!c. i' Date: / `1-'/%( <br /> Permit Granted By: A ."- Date: <br /> (Town of Springfield Designee) <br /> (White copy-Town, Yellow- Applicant, Pink-Dane County Zoning) <br />