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. TOWN OF MADISON Application No. <br /> 2120 Fish Hatchery Road � �� <br /> Madison Wisconsin 53713 Date <br /> APPLICATION FOR DRIVEWAY PERMIT <br /> (Drawing must be attached in duplicate) <br /> Location 401 V■ , f&1 l /he_ 147- Parcel Number <br /> Property Owner od grµwe r. - ) to Kee w,►tii-f z <br /> Name of Company and Owner or Agent Telephone Number <br /> Job Contractor ( r►oyve -140Ae <br /> Type of Driveway: Class I Class II ✓ (check one) <br /> Width ZAb Feet; I/9 Feet from Property Line; N A Feet <br /> from right-of-way line of intersection; Shoulder construction M. A, <br /> or raised curb r/ (check one) Edge Radius feet; Angle to <br /> pavement edge ql) O; Grade of approach G}-°Aa ° <br /> Plantings on right-of-way area -}-r-ee_S <br /> (grass,flowers or low growing shrubs) <br /> (Attached drawing shall show the following: Driveway and approaches; property lines; <br /> right-of-way lines; adjacent intersecting roads, streets or railways within 100 feet; width <br /> and type of road surface; width of right-of-way; distance from right-of-way line to <br /> gasoline pumps and other structures on the site; type of surface and width of driveways; <br /> type of surface and width of approaches; proposed turning radii; proposed treatment of <br /> right-of-way area adjacent to and between approaches; rate of slope or grade of <br /> approaches and driveways.) <br /> Special <br /> co V 1 orov ision PAoof of public liability insurance <br /> - tv-19 fik ( 0.L [9 41 h 5 V.-row..c¢, f C 5-1-r <br /> pt c---17 err <br /> eArv1- 15 Nto-r`o( tC 5 i- �� S.I1a g L"rr 5 ho+ a.P.r-oved, <br /> Applicant does hereby agree to conform with all requirements of Town of Madison <br /> Ordinance No. 4-3-1 and 4-3-2. <br /> Approved <br /> Applicant Signature <br /> /C.-7Z, zt.) <br /> Printed Name <br /> irector oft Public Wo ks <br /> Date -ZB ~0(b Fee X25°� <br /> p TR# 3 <br />