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DATE: `t... 11- 67 Town of Springfield Fee: 1 a .co <br /> Driveway Permit Ck.#: O <br /> Name & Address of Applicant: Driveway Location: <br /> L�cG cG�S,rua;�.� Road Name: 5070 <br /> 2- 3 fh«'k, i'f q c,. 1/ 5 k J c 2 G / 5 kr - kit Hey C o L4(+- <br /> (NOE/W) side <br /> 14-1,c J,15,0"), her 53717 0.4 a t' , ? SGa <br /> Feet (N/S/E40 of <br /> Phone: Co 6- 27c - r6 co Section: 3 a Lot # <br /> Subdivision po,i. <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 /> X Culvert (made of corrugated metal),with approved end walls, if required <br /> Size: 3` x 30 <br /> Signed certification that applicant agrees to abide by town ordinance <br /> Applicants Signature ri - a' c.4 Date: 09,` I/ `e 7 <br /> Permit Granted By: .Z:1- , ._ Date: <br /> (Town of Springfield Designee) <br /> (White copy - Town, Yellow - Applicant, Pink - Dane County Zoning) <br />