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n <br /> TOWN OF BLUE MOUNDS • M' <br /> DANE COUNTY, WISCONSIN <br /> DRIVEWAY CONSTRUCTION APPLICATION,' <br /> PERMIT AND INSPECTION FORM <br /> PART =: (Application) <br /> TO THE TOWN BOARD; The undersigned hereby applies for a permit to <br /> construct a driveway in the Town of Blue Mounds, Dane County,, <br /> Wisconsin. The driveway will be in Section aft( 'of he Town of <br /> Blue Mounds, off Hwy or Town Road 2,6712r.,sA, <br /> , through the property owned by: <br /> Name of Property Owner 16 d K roc k\ <br /> Signature 11E24/14.e. <br /> `.. Date S.- I(�" C b l <br /> Mailing Address 8-7 9 d (ZtC) <br /> M\ . 42% , os <br /> Name of Applicant R t j Jfl4 ,yKsVCa jP4-64, <br /> signature /1; ,� ///; Date S-16%.100( <br /> Mailing Address ?a3 1pr)■,-43 /#y,e.Q_ (P-4 <br /> e l c.t..tz Who cis <br /> Contractor stD lo•e d ey <br /> A driveway- construction plan and erosion control plan will be <br /> presented to the Town Board by f4W- to 5ó-c CcA∎61-✓o, jc,r", . <br /> Does applicant desire to use material from the excavation of the <br /> house site to provide fill for the proposed driveway? <br /> ` NO <br /> YES (If "yes", an excavation permit must <br /> be obtained from Town Chairperson. <br /> Proposed driveway length (in feet) rb <br /> Application fee $ 66. O <br /> Date fee received 3 _ ,9 1 <br /> (over) <br />