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r , <br /> !lie a is z,,,'' <br /> Town of Sun Prairie Driveway Permit Fee:$50 <br /> Road Damage Escrow: . $:2-7(C)(7' <br /> 5556 Twin lane Road <br /> Marshall,WI 53559 Location! 1s4- Sg Pn3Sface_ivr" L,n- <br /> fffn.cer- ,A left <br /> j,.y It4 of Ot.FI-h .-1-" 114,Scc. <br /> Application to Permit to Construct a Driveway <br /> (Access from private property to a town road) <br /> REQUEST BY APPLICANT <br /> Name Q Ft t 1 J 4 vp s /vet 14 vut Lt 4 <br /> Address -i MO A/14wl E1 e&I-- 1 W I&.-1't(t` . of "> i 1 6.Q Q <br /> Office phone atp2• O3.4 1 Local phone- a(Da.y:53,0 ty 4-}Fax: j/9), (,Dg te:thb ti <br /> Plans Prepared by $;Yf2 h1(04 SR YE46 Copy Enclosed .1/".Yes No <br /> — <br /> Location of Proposed North,South,Ot, West Side of j'v.DSpi (,.+....r- Lad <br /> Access: "'�� <br /> Section# Feet/Miles from <br /> The applicant understands and agrees that the permitted work shall comply with all permit provisions and conditions <br /> listed on the reverse side hereof,any special provisions listed below or attached hereof,and any and all plans,details <br /> or notes attached hereto and made a part thereof. <br /> By /i /L %� a.._ ____ Title a ,dam-�11-- c 1457' <br /> 5 tune of Appoint <br /> Date /0/1 ? 1—} <br /> iii*************I4M r�k <br /> 4******** ****6t4Alt*******44ii*****44****hill****ir*Iil*****ltq*itt/*****1**** <br /> I I\o Width of driveway Gi 111 1r-1 k✓ '�/ <br /> • Center of dri'.ewa y from property line: A 0 1 t _�4' t <br /> • Drainage Culvert Needed ., _ No Drainage Cuhert Needed _____ <br /> Size: Length:. r. 1-1 ______ feet !/, .. it/cA i✓..A 1.LF-6-i <br /> Diameter _.__Lys_.----._ --_ inches <br /> All Culrertc are to have ends <br /> Other All construction equipment must use this entrance to access tot.All Culverts must have ends <br /> Requirernertts (wings).Culverts are to he completely installed prior to tittat inspection and approval by public <br /> works personnel. <br /> No construction materials are allowed in the public roadway.Dumping of landscaping <br /> materials(mulch,stone,topsoil,etc.)on the road will cancel the return of the$2,000 escrow. <br /> t he Iowif rettuire%the Owner and Contractors)initial that the lime rend and understand, <br /> these terms. <br /> (...;,,,it:: its' ( ;:, r <br /> , • <br /> DAt11.1�"Pumit Pr tulun: Rc,?t!t 7 Rte.t.sut,keep,ol 3 1131417 <br />