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Linn; e <br /> eg- *$15- • 46 3z- <br /> Town'of Burke <br /> Driveway Permit Application <br /> (Access from private property to a town road) <br /> NAME OF APPLICANT: roof, SIoe- gor-,eS 'Mt,3s "dl�retg <br /> ADDRESS OF APPLICANT: I 3 v -��.�,le � f v A.- .S •ye Q00 <br /> C2ecp-,0>.,ecvc.c7 L,.ti S 3 vE, <br /> PHONE NUMBER: G - y'_ / , 7 7 <br /> PROPERTY OWNER: C k i„e k Ti 4 4 $o n <br /> LOCATION OF PROPOSED ACCESS: <br /> Lot # V Subdivision gam,.'Ae_ Co -s Nr e,/ Street �..-/ e 12oq,/ <br /> FSter <br /> North, South, East, West side of JS k c f2 o.:. / 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 /> �-�-J Date: c?- <br /> Applicant si ature <br /> Permit granted: /1.0i ,� "2-1_ Date: <br /> rz/a( <br /> a fficial/D: ignee Sign/ re) e p„,;_ <br /> ,404 64. fc1/1-7/7e <br />