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DATE: Town of Springfield Fee: / i <br /> Driveway Permit Ck. #: / , // <br /> Name & Address of Applicant: Driveway Location: <br /> ' / <br /> � <br /> � 4i- N 6 i _. : -c Road Name: /L't v I , 1 J. <br /> .( ) `" 7,, . \. k'` j- <br /> (N/S/E/W) side <br /> Feet(N/S/E/W) of <br /> Phone: ) t Section Lot# i L <br /> Subdivision <br /> y , <br /> i . f/ . <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 /> 1/ Culvert(made of corrugated metal), with approved end walls, if required <br /> Size: ' .8 " <br /> Signed certification that applicant agrees to abide by town ordinance <br /> Applicants Signature Date: S/12 E <br /> Permit Granted By: / Ci,, / " ts.- Date: 5 /Z g.,/(• <br /> (Town of Springfield Designee) <br /> (White copy- Town, Yellow- Applicant, Pink- Dane County Zoning) <br /> 4) <br /> I r f Co:"41 .71(..,,..:(41 L.,c.-i <br /> e 14,4 4,444,- I;., /'0., ,iqz. 17k k C C.— /71 1 <br /> .e!.442(1-°- <br />