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DATE: Town of Springfield Fee: x'40 <br /> Driveway Permit Ck.#: ((-J (r a o <br /> /.Z-3D-oI <br /> Name & Address of Applicant: Driveway Location: <br /> /etti 1 Road Name: .y t 1` r L <br /> iv <br /> (N/S/E/W) side <br /> Feet (N/S/E/W) of <br /> Phone: 7 Section: _ / Lot # <br /> Subdivision //- 4 /,; ,, <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 /> L' Culvert (made of corrugated metal),with approved end walls, if required <br /> Size: , if I <br /> 4- Signed certification that applicant agrees to abide by town ordinance <br /> ( _ <br /> Applicants Signature .A y} - Date: <br /> lif <br /> Permit Granted By: r" /1J Date: f` ii, <br /> (Town of Sprin: "-eid Designee) <br /> (White copy - Town, Yellow - Applicant, Pink - Dane County Zoning) <br />