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TOWN OF BLUE MOUNDS <br /> DANE COUNTY, WISCONSIN <br /> DRIVEWAY CONSTRUCTION APPLICATION, <br /> PERMIT AND INSPECTION FORM <br /> PART I: (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 21 of the Town of <br /> Blue Mounds, off Hwy or Town Road Section , Sj i,,jo <br /> through the property owned by: JJ <br /> ll <br /> Name of Property Owner h+2 1-k,lk bOIV' LL <br /> Signature ./It " 1 Date 1 � iS <br /> Mailing Address 15)-3 J 1`il t Rd 7i <br /> titwS 51571- <br /> Name of Applicant TAc fiti,/ flo,r, Lt.( <br /> Signature Date <br /> Mailing Address �5 Z3 � �{ 4 7 <br /> M . i(4r1- ; w- 5-15-7 <br /> Contractor 1115.+1t, Cs/21-0 1400i <br /> A driveway construction plan and erosion control plan will be <br /> presented to the Town Board by 41 -14 -147 <br /> Does applicant desire to use material from the excavation of the <br /> house site to provide fill for the proposed driveway? <br /> X NO YES (If "yes", an excavation permit must <br /> be obtained from Town Chairperson. <br /> Proposed driveway length (in feet) 21 <br /> Application fee $ ��0, Od Pee <br /> Date fee received <br /> (over) <br />