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DATE: Town of Springfield Fee: <br /> Driveway Permit Ck. #: <br /> Name & Address of Applicant: Driveway Location: <br /> Road Name: Au L.4,/,n R.A.1 <br /> (N/S/E/W) side <br /> e5 ani L), 5 S 3:15 NA) * 0 f <br /> Feet(N/S/E/W) of <br /> Phone: (,(A- i✓`/3-Z 1(6'5 Section 3/ Lot# 19 <br /> Subdivision /\ rPc.r,1 <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 /> Culvert(made of corrugated metal),with approved end walls, if required <br /> Size: 1 e x <br /> Signed certification that applicant agrees to abide by town ordinance <br /> Applicants Signature f �„� / Date: //- <br /> Permit Granted By Date: <br /> (Town of Springfield Designee) <br /> (White copy- Town, Yellow-Applicant, Pink- Dane County Zoning) <br />