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(C <br /> Town <br /> n of Burke <br /> Driveway Permit Application <br /> (Access fro 1,private property to a town road) <br /> NAIvi OF APPLICANT: `,I � � c � <br /> ( <br /> ADDRESS OF APPLICANT: S <br /> PHONE NUMBER: C 040 <br /> PROPERTY OWNER: � � / / <br /> OCATION OF PROPOSED ACCESS: <br /> Lot r / Subdivision L's/1 /37$U <br /> Street <br /> North. South. East,abik ide of 74 ors-a-,,, <br /> Town of Burke- Dane County. Wisconsin Road <br /> PERMIT CONDITIONS <br /> (To be completed by Town Personnel) <br /> Driveway is 24 feet wide. I request a variance of <br /> feet <br /> All culverts are to be 24 feet Ion, Diameter is 18 inch arch with end walls <br /> (winos). <br /> No drainaze culvert needed <br /> I ; Variance from size needed. �`� l�e is s�{�%�/ <br /> w 4 y is � f 74-0 ek-e-ee d p21 <br /> Other Requirements: _. <br /> All construction equipment must use this entrance to access lot. Culverts are t <br /> completely installed prior to final to be <br /> ins ection and approval by highway personnel. <br /> I ackno Q t /)44 .4 -e• dinance and agree to follow all terms. <br /> Ap>acan* c;. .a„� e Date: <br />