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New Driveway: $100.00 permit Existing Driveway: $100.00 permit <br /> $2,000.00 Bond $1,000.00 Bond <br /> Town of Burke <br /> Driveway Permit Application (new or existing) <br /> (Access from private property to a town road) <br /> NAME OF APPLICANT: U I-im e ( � i ( t'tc . <br /> ADDRESS OF APPLICANT: A 82-1 P l Pl 1J t t Oc > <br /> CLG1e V\ 1 3-'7 <br /> PHONE NUMBER: (OO — 'Z 33 <br /> PROPERTY OWNER: )re-hi I l'' 1 haTif 4'i' ebb `3oii <br /> LOCATION OF PROPOSED ACCESS: <br /> Lot# c2.. W Subdivision i Mk C p+ Street KS ,t 1/1 Natal. <br /> North South, ast, West side of 111 ti SO n ROCuk 3313) Road <br /> Town of Burke, Dane County, Wisconsin. <br /> All culverts are to be 24 feet long. Diameter is 18 inch arch with end walls (wings). <br /> Driveway is/is not 24 feet wide. If not 24 feet, I request a variance of feet. <br /> All construction equipment must use this entrance to access lot. Culverts are to be <br /> completely installed prior to final inspection and approval by highway personnel. <br /> I acknowledge receipt of attached Ordinance, included fee and escrow in two separate <br /> the ant . - to follow9terms as stated in the Town ordinance. <br /> A�11%J �r Date: 3i <br /> : .. leant signature <br /> ********************* **** . ******************************************** <br /> PERMIT CONDITIONS <br /> (To be completed by Town Personnel) <br /> { } No drainage culvert needed r , Fee Rec <br /> { } Variance from size needed. } Escrow R ceived <br /> { } Escrow Returned <br /> Additional <br /> Cenditions: CMk.- - "--b ` 10/1 4 i iar 4 J ,,,_Aw <br /> , `i��� /`�' � � � . = � � L � ��iii � <br /> .. TLS <br /> �'� - —3 <br /> Pe mgt grantee: till Date: / �(Town Official/D <br />