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DATE: /C /%) D Town Fee://17P <br /> 17P <br /> w of Springfield 1 <br /> Driveway Permit ck.#: e 7 <br /> Name & Address of Applicant: Driveway Location: <br /> G f :T o r .1 p (7 /)F rtie J Road Name: A r ,4r1,4 L <br /> i l <br /> (N/S/E/W) side <br /> I r _ <br /> /U <br /> Feet (N/S/E/W) of <br /> Phone: --, 7)'n) 2 - r Section: 3 ) Lot # <br /> Subdivision /f -14-0 , a <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 /> M <br /> Erosion control permit if needed <br /> Culvert (made of corrugated metal),with approved end walls, if required <br /> Size: m►ri a ► I �Q <br /> Signed certification that applicant agrees to abide <br /> g pp g by town ordinance <br /> (1 <br /> Applicants Signature - . Date: t i - i 0 06'099-d <br /> Permit Granted By: Date: // <br /> (Town of Springfield Designee) <br /> (White copy - Town, Yellow - Applicant, Pink - Dane County Zoning) <br />