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\A/NCI- DrN101'; t_E- 1.2AIu 6 <br /> DATE: Town of Springfield Fee: <br /> Driveway Permit Ck. #: 5.5-2/a <br /> Name& Address of Applicant: Driveway Location: <br /> C G I_[_. j A .• Road Name: V-1»_C>1,_.0 Lac- <br /> 4191(0 1.. ti i=.- C_-L U C•Z:ii I Da <br /> (N/S/E/W) side <br /> �1- ' 7:` <br /> Feet(N/S/E/W) of <br /> Phone: (LOS) 3;:_ 6 - Section Lot# 3 <br /> Subdivision G1 <br /> • <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: i i'v° ° > c. <br /> Signed certification that applicant agrees to abide by town ordinance <br /> Applicants Signature v' Date: <br /> Permit Granted By w— /i``"'�-i Date: <br /> (Town of Springfield Designee) <br /> (White copy- Town, Yellow- Applicant, Pink- Dane County Zoning) <br /> • <br /> L.f <br />