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TOWN OF DANE DRIVEWAY PERMIT <br /> Date — • �[' ( , c/.q Pee ! DO Ck# It ° <br /> Name and Address of Applicant: Driveway Location: <br /> U6-(-A3 J/GG LcSv,, o/_ Road Name //3 <br /> 7/ 71 0=O /13 /ZO t,J' r 5//D� <br /> (NtS/F/W) side <br /> i9/' k)&:- 5 3 5 a <br /> Feet.(N/S/E/W) of <br /> Phone(6 & 9 ` 5 6 Section: o�I N . %. O r <br /> CONDITIONS: <br /> For access from private property to a Town road the permitted driveway must meet all requirements Per <br /> Town Ordinance# 1002. <br /> Signed certification that the applicant agrees to read and abide by the Town Ordinance. <br /> Applicants Signature (. `�. �, s/ y 4 Date_ <br /> ° 2- 5 °7 <br /> Permit Granted By � �. / ---: __.. <br />