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TOWN OF BLUE MOUNDS <br /> DANE COUNTY, WISCONSIN <br /> • <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 3y of the Town of <br /> Blue Mounds, off Hwy 7S or Town Road <br /> , through the property owned by: <br /> Name of Property Owner ✓ #r tl • <br /> Signature -� - _ G u 'v Date' /67- ( --"Oct <br /> cv I/Uk L e �'( 5-3 5 <br /> Mailing Address l KO I'� I 788 rnf i 7 <br /> Name of Applicant t • 7 Ain <br /> Signature rL! ` iii Date /0-/-2— C1 <br /> 0 <br /> Mailing Address / L(,' -75 DIci,' 5-357 <br /> Contractor G� �' 1 O11 5 tu cf/o /.11/ S toil 116 ti <br /> A driveway construction plan and erosion control plan will be <br /> presented to the Town Board by /0 - J' -- O <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) ' 7d <br /> Application fee $ �OO� 00 <br /> Date fee received / <br /> (over) <br />