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FEE: $250 <br /> TOWN OF SPRINGDALE <br /> 2379 Town Hall Rd. Mt. Horeb. WI 53572 <br /> (608)437-6230 townofspringdale;rimhtc.net <br /> DRIVEWAY PERMIT APPLICATION <br /> Please return this application and the following to the address or email above: <br /> • Sketch of driveway location on Town-approved site plan; <br /> • $250 application fee;and <br /> • Copies of deed restrictions or other property agreements that may impact the driveway location. <br /> Once received by the Admin/Clerk,the Town Board Chair will arrange a site visit. Please ensure the proposed <br /> driveway is staked before the visit. <br /> APPLICANT INFORMATION (Completed by applicant;please print) t� <br /> Applicant Name(s) .t��h <br /> CCR IM plot 1 1 Date VZ/�'cfAO 2 <br /> St)? (8 41 S- — NI QA-k5 wr 53r7T <br /> Applicant Address: �/ <br /> Phone - -i y - / &I3 Email !t c ct.iipbe!l ckru/ ;AS t4.1_ <br /> ! 1 J Col by Rd '1 ) (i13DD Shared?Y /© <br /> Driveway Address ' ' ' <br /> • y <br /> N,�'E/W side of Lp-t'' Sec. 3a Parcel Number: t5J/0(p0732 /- "‘:° <br /> l D KQso <br /> CONDITIONS (Completed by Town) <br /> Dane County and DNR regulations may apply;contact local offices. All driveways and culverts must comply with <br /> Springdale's Private Driveway Ordinance and Driveway Construction Guide. Driveway permits parts I &2 <br /> must be secured prior to receiving a Town building permit or Dane County zoning permit. Approval is subject to <br /> conformance with building envelope on file at Town Hall. Duplicate rural numbers are required for shared <br /> driveways. Blue oval markers are required on address posts for driveways longer than 1,000 feet. <br /> Engineered plans required Y �� L da e <br /> ciii-714cd/ <br /> Shared driveway agreement required yCulvert /j� iefMAgricultural use only Y/� u� <br /> Width single: 12' driving surface, 14' road bed4,7/4 <br /> shared: 16'driving surface, IS' road bed 517: 1-/V15461) <br /> Grade 10%maximum <br /> APPROVAL (Completed by Town) id re/! `° <br /> Permit is valid for 1 year from dateofapproval. Permit pending CSM recordation at Dane Co. Register of Deeds. <br /> Fee Received: IH---2-02-/0(Date) S1, <br /> TB Approval: <br /> Part 1 Issued: <br /> Part 2 Issued: /7.4/41/ <br /> By: <br /> Town Chair <br /> I Revised 1/21/21 I <br />