Laserfiche WebLink
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 .0 of the Town of <br /> Blue Mounds, off Hwy or Town Road <br /> , through the property owned by: <br /> Name of Property Owner ,►YO l'VLQ,5 C. 5 '7<11,r' <br /> Signature / ^ J 0� �Ud Date 3 - I 5''- 41 <br /> Mailing Address /o.$ '( w P,J _ M d5 iU- <br /> 61u,c 5 3c/ <br /> Name of Applicant Sa KO-- <br /> Signature Date <br /> Mailing Address <br /> Contractor Sea n 5 U f `e{- <br /> A driveway construction plan and erosion control plan will be <br /> presented to the Town Board by - -_ a °''" <br /> Does applicant desire to use material from the excavation of the <br /> house site to provide fill for the proposed driveway? <br /> NO YES (If "yes" , an excavation permit must <br /> be obtained from Town Chairperson . <br /> Proposed driveway length (in feet) C- 'd' ©42 �lr 6`�✓ � 09 <br /> Application fee $ O� <br /> Date fee received <br /> (over) <br />