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T1¼T OF COTTAGE GROVE <br /> DRI AT PERMrT <br /> (For access fr. i private property to a town road) <br /> N e and address <br /> of applicant <br /> Ple filcl -e.r Ai C.,12r I3irc <br /> )2- ././ ii.://, c6,-/ bri '--1-` <br /> tfilka, ket , tJI [_-_;'5,5,-) 7 <br /> iv ,:yI, ,.),,,,,,,7:,— , <br /> Phone (ciA6 i - /,' ,i'() <br /> -) <br /> Location: . _. _,) r aideawtisi-,6 )..: /:(1,/ <br /> g <br /> located 0 5- ( 8/feet fr. . 6The - Re <br /> in Section / , Town of <br /> saieoposisossesoiposoisoomooseogRome000sieseseoesossorosoupeipootseres•Seeipe <br /> CONDITIONS <br /> Width of driveway: /P feet. tool <br /> Center of driveway from property line: 61- 1 <br /> feet. <br /> [ ] No drainage culvert needed. <br /> 0 Drainage culvert needed Size: Length 'N' (91(1 <br /> 0' <br /> feet n101, <br /> Diameter /79 inchea. <br /> Other requirements: <br /> •r,,t4 ijcLel c ---- e2r,,4 e\e) <br /> Permit grante. . ,___ c i - Date <br /> Town of: a i f (2IfIlV __ <br /> [White copy-Town; Yellow copy-applicant; Pink copy-Dane County Zoning] <br />