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TOWN OF SPRINGDALE <br /> DRIVEWAY PERMIT APPLICATION <br /> Please complete section 1 below. Return completed application and 5250 permit fee to Town Hall,along with a <br /> drawing of the proposed driveway location on a previously approved site plan. as well as copies of any deed <br /> restrictions, property agreements, etc.that may impact the location of your dri\eway. Once the application, <br /> documents and fee have been received and processed,the Town Board Chairman will arrange a site visit. Please <br /> ensure the proposed driveway is staked before the visit. <br /> itequirenrc•nts <br /> All Town driveways and culverts must comply with Springdale', Private Driveway Ordinance and the Driveway <br /> Construction Guide. Driveway permits parts 1 and 2 must be secured prior to receiving a Town building permit or <br /> Dane County zoning permit. Permit approval is subject to conformance with the Town-approved building <br /> envelope(s)on file at Town Hall. Duplicate rural numbers are required for a shared driveway. A blue oval marker on <br /> the address post is required for driveways longer than 1.00(feet. <br /> • <br /> 1.APPLICANT INFORMATION <br /> (Completed by applicant;please prim <br /> L-1...N:\ittL-'� L\ ''' _; :\I'PLICr�7'[ON DATE l0 �°1 �: <br /> ADDRESS 5 / L aKkei, �)ane / V a r a nit 1��.,3 i _53.S '13 <br /> PHONE(S) _OP. _ , 3'j -_.1_(. pthKsr`_) — EMAIL1..0-3 <br /> C): O_1 k-Not,/. corn <br /> DRIVEWAY LOCATION L ia' 1 D 43aacci.L_______ _.____.S1lAREl)Q 'A N (circle one) <br /> N S�iE/�V side of Lqt" ( C.c)(1`\ Sec. _ PARCEL NUMBER: ' �.0 t - 0✓-! ` 88?'O-o <br /> 2. CONDITIONS • <br /> (Completed by tom:board member or its gc'tzt) <br /> Engineered Plans Required: Y / N <br /> Width: sin Tle-use: 12' drivitt; surface, 14' road bed - ,.., <br /> shared: 16' riving sttt Parc, 1 road bcc�-i 2-- <br /> Grade: 10% maximum Shared driveway agreement required/N <br /> Culvertt/Y i N Agricultural use only: 1' l e <br /> ********************:**********************************4. <br /> **K*******+k********:****:K:i+:l*Kae4A:d::K K**********:&=r*****:i::K4. ••*****ok***** <br /> Dane County mid DAR regulations may crlrlrhv. c•uruart local of/ic•ec. <br /> 3. APPROVAL <br /> (Completed by town beard member in.its agent) <br /> Date Fee Received: tG !_ }. Date Approved by Town Board: ////Se <br /> _... � ' <br /> Date Permit Part I Issued: _._ Date Permit I art 2 Issued: _//f.(7/G'{i rte" <br /> Dr•irewar Permits are valid/nr one (i)year from date of approval. Drivenyty Permit is pending <br /> recordation of the Certified Surrey Map at Dane County Register of Deeds. <br /> I Revis:d s'27'20 1 <br />