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. /.4 7#_---- 5 h a 14v <br /> Town of Burke <br /> Driveway Permit Application <br /> (Access from private property to a town road) <br /> NAME OF APPLICANT: S "Si.4*t_CA4&21v 4Mines Li- G <br /> ADDRESS OF APPLICANT: 41,5.2 6 6' Ail 4I I( iz , e <br /> /UCH Glo ei5 h✓, 57 <br /> PHONE NUMBER: 6'A- 5-27- 33'1.0 <br /> PROPERTY OWNER: :7... x.,1.60 ; <br /> LOCATION OF PROPOSED ACCESS: , <br /> Lot# 46, Subdivision .�__ __ �. // Street bet keS G it.Gt'e. <br /> North, South,East, West side of eQ5-1- Road <br /> Town of Burke,Dane County,Wisconsin <br /> • * * * * * * * * * * * * * * * * * * * * * * * * * <br /> PERMIT CONDITIONS <br /> (To be completed by Town Personnel) <br /> Driveway is 24 feet wide. I request a variance of feet <br /> All culverts are to be 24 feet long. Diameter is 18 inch arch with end walls (wings). <br /> { } No drainage culvert needed <br /> { } Variance from size needed. <br /> Other Requirements: <br /> All construction equipment must use this entrance to access lot. Culverts are to be <br /> completely installed prior to final inspection and approval by highway personnel. <br /> I acknowledge receipt of attached Ordinance and agree to follow all terms. <br /> l Date: "�" 0 g <br /> Applic ignatur-� �� <br /> Permit granted: / <br /> dp, _ Date: 9 _ <br /> icia i�,�.isna,urct <br /> 0 ii by-. elle-1: -aP2-41-2--- <br /> Td Wd90:170 800E to 'daS £17T8LES: '0N Xdd SSWOH GNU A2l1N8d'cltiO NfS: WOZId <br />