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. . <br /> D,,,, _{,z. -p, , 1 . c <br /> TOWN OF SPRINGDALE DRIVEWAY PERMIT APPLICATION DATE: g/LQ/O K <br /> - I. CONTACT INFORMATION - To be Completed by Applicant: 1f1 <br /> Name and current address \VVI OA Yr.p b 3 u_ <br /> of applicant <br /> 9O( 9- 120 C- ` ( e-7/21 C(.? <br /> Current telephone number: work 09-51519C( home (r-- '3g1.11..0 <br /> Driveway location in Springdale: (3C L 2 9O fob 2 <br /> TMh/ A76 <br /> Location: k west east south X north side of(TZ JO. Sec. (u <br /> Parcel number: r,(Q 0 7- 0 L. - if 765 -- C) (srn4 119 9`/ <br /> Contact Ed Eloranta, Town Chairman, #437-4692, to arrange a site visit. <br /> Please attach a drawing of the driveway location discussed at the site <br /> visit and return to the Town of Springdale, 2379 Town Hall Rd. , Mt. <br /> Horeb, WI 53572 as soon as possible after the site visit. <br /> II. CONDITIONS - To be'completed by Town Board member or its agent: <br /> Width of driveway:/ �Tlc� feet imam grade of 10%. <br /> Drainage culvert needed: no yes <br /> If culvert required, must meet Driveway Construction Guide standards. <br /> • Agricultural use only: ,7 no yes <br /> - -Shared driveway agreement required: A/no yes <br /> Other requirements:: <br /> 1. Shall comply with town private road ordinance and driveway <br /> construction guide for new driveways. <br /> 2. Shall contact Town Patrolman Dan Chancellor at 437-3648 before <br /> starting construction of the driveway. <br /> 3. No Building Permit shall be issued until Driveway Permit Part 1 AND <br /> Part 2 has been issued. - <br /> 4. <br /> ******************************************** * **************** ** *** <br /> III. APPROVAL - Date Approved By Town Board /� Date Issued: "��j <br /> The Driveway Permit is valid for one year from date of approval. <br /> • The Driveway Permit is pending recordation of the Certified Survey Map . <br /> at Dane County Register of Deeds <br /> r i.t Part 1 Driveway Permit Part 2 in�le Residence Duplex <br /> $100.00 Fee ✓•Reminder:I)ane County Erosion Control Standards may <br /> apply. #340 0918)- <br /> • <br />