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09/28/2006 09:11 6684374181 CAVE PAGE 03 <br /> • <br /> TOWN OF BLUE MOUNDS <br /> DANE COUNTY, WISCONSIN j <br /> DRIVEWAY CONSTRUCTION APPLICATION, 1 <br /> PERMIT AND INSPECTION FORM <br /> PART I: (Application) <br /> TO THE TOWN BOARD; The undersigned hereby applies for a pegmiE to <br /> construct a driveway in the Town of Blue Mounds4 Dane 'County, <br /> Wisconsin. The drivewa will he in fiect_ion d :of 'the Town oyy`,�,, <br /> Blue Mounds, off Hwy or Town Road Ca,r e4 t1.t leed„,.Ii F&• <br /> through the property owned by: <br /> Name of Property Owner t 6EN&*E?E le 154eNS 4... I C L C1 • <br /> fir, _ w�tr� M-� <br /> Signature t. *uu-�-. �• Gr.. DJte ( 212'ZI05T <br /> t <br /> Mailing Address 22 5-+ - - VAL 41- t4 <br /> M - : -cQe� t ( J 5.3 5 <br /> Name of Applicant <br /> Signature Date /a f 0/1.ao <br /> Mailing Address P 0. aor vac <br /> tv� n?oJAlDS 'I us-17 <br /> 1 <br /> Contractor Set 1 <br /> A driveway construction plan and erosion control planiwill be <br /> presented to the Town Board by a H a c44.1• I� <br /> Does applicant desire to use material from the excavation of th.a <br /> house site to provide fill for the proposed driveway? <br /> NO YES <br /> (If "yes", an excavation permit must <br /> be obtained from TownIChairperson. <br /> Proposed driveway length (in feet) a pprQfl 3Zs- FE• <br /> Application fee $ , 00, <br /> Date fee received rY-C16‘ ; <br /> (over) <br />