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'.1 <br /> • <br /> •l <br /> Town of Burke <br /> Driveway Permit Application <br /> (Access from private property to a town road) �- <br /> NAME OF APPLICANT: � � s�� LJS /44-7/)ADDRESS OF APPLICANT: 4/0 L re,/, <br /> ()1 4 0 4 a_ ,1. s S 7/4 <br /> PHONE NUMBER: 6 og--Z-7 -- S7b <br /> PROPERTY OWNER: r t Ie_ d <br /> LOCATION OF PROPOSED ACCESS: <br /> Lot# .3 Subdivision Street 1.---/1 v r..;e,m <br /> North, South, Eas est 'de of (L e r ' Road <br /> Town of Burke,Dane County, Wisconsin <br /> ************************************************************************* <br /> PERMIT CONDITIONS <br /> (To be completed by Town Personnel) <br /> Driveway t wide. I request a variance of feet <br /> All culverts are to be 24 feet long. Diameter is 18 inch arch with end walls (wings). <br /> { } No drainage culvert needed <br /> { } Variance from size needed. <br /> Other Requirements: <br /> All construction equipment must use this entrance to access lot. Culverts are to be <br /> completely installed prior to final inspection and approval by highway personnel. <br /> I ac.••. dge receipt of hed Ordinance and agree to follow all terms. <br /> _ Date: _s� -S 2G?f,6 <br /> Appli I •ignatur ? <br /> P ermit gran ted: r i" Date: ce.14- 4- <br /> (Town cial/Designee Signature) <br />