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Town of Madison <br /> 2120 Fish Hatchery Rd <br /> Madison W153713 <br /> Ph:608-210-7260 <br /> Fax:608-210-7236 APPLICATION FOR DRIVEWAY PERMIT <br /> (Drawing must be attached In duplicate) <br /> Location 07a�1 -31�3 a3y� <br /> ct>& ° tJ�/o�t.a���Gw� p Parcel Number <br /> Property Owner NC sou/WOCAJ )`(12_! \A—C- 11C—W12 —0 3(-3 <br /> Name of Company and Owner or Agent Telephone Number <br /> Job ContractorCA/1.5■Ipfrr-e-S(Iti,ll02i P rc\eJ I' Sbc.c os �,r1c- C 'V <br /> Type of Driveway: (check one)Class! (residential) Class 11 (commercial) <br /> • Width a if Feet I <br /> • 3$ Feet from It)0,4- Property Line <br /> • X13 Feet from right-of-way line of intersection <br /> • (check one) Shoulder construction Raised Curb )C <br /> • Edge Radius feet lircit.ra 4 kJo <br /> • Angle to pavement edge a--a degrees i kpQCQ d <br /> • Grade of approach 5-'7 degrees t b °Jo <br /> • Plantings on right-of-way area (f*S 5 <br /> (Grass,flowers or low growing shrubs) <br /> (o** J1 dramArrg shaft Amami the followlna:Driveway and approaches; property tares;right-of-way <br /> lines;adjacent intersecting roads,streets or ra ys w' n , , '_: ,, • • .. • • • ..... -_,_ <br /> width of right-of-way;distance from right-of-way line to gasoline pumps <br /> and other structures on site; <br /> type of surface and width of driveways;type of surface and width of approaches;proposed turning <br /> radii;proposed treatment of right-of-way area adjacent to and between approaches;rate of slope or <br /> grade of approaches and driveways.) <br /> Special provisions:Proof of public liability insurance <br /> IA -'ho, we rd ft) i !l I! <br /> Po- 'Pat -- 0 L 13 +0 ins c ct- Qrt 1 d -to pouf r- t .tom <br /> Applicant does hereby agree to conform with all requirements of Town of Madison Ordinance No.4-3-1 <br /> and 4-3-2. <br /> Approved <br /> � r. :tore <br /> ./► � '� Printed Name <br /> Business Manager <br /> Date (e 1 Z 2 j )4. Fee $35.00 TM 69(1/3 <br /> 19d wz8//9- <br />