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V <br /> cv <br /> DATE: , Town of Springfield Fee: /5 <br /> Driveway Permit Ck. #: <br /> Name& Address of Applicant: Driveway Location: <br /> GO/W , -/'%I-' X40-,m, L Road Name: 4,442."--; <br /> (N/S/E/W) side <br /> Feet(N/S/E/W) of <br /> Phone: 309 ,).'' 'f giAL Section / Lot# al <br /> Subdivision (, <br /> 4,a-S97- S79/‘' <br /> CONDITIONS: <br /> L)t.1\4 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 /> 1 r <br /> I� Size: 11, ltari� J • 0(o h/Ckne5s der 7/17/�� P�7�cc( Ci-Urn Blue. Ltnc-less = <br /> J <br /> Signed certification that applicant agrees to abide by town ordinance <br /> Applicants Signature r Date: <br /> DAN 3c-- IL , Glue L 1& txtsi r s <br /> Permit Granted By: Date: <br /> (Town of Springfield Designee) <br /> (White copy-Town, Yellow-Applicant, Pink-Dane County Zoning) <br />