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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 _?y 'of the Town of <br /> Blue Mounds, off Hwy 7 or Town Road <br /> , through the property owned by: <br /> Name of Property Owner ft t A fr# i ' <br /> Signature ;--� . 2 2 �41/hzti Date <br /> /d_ ( - <br /> /KO5 i w�' 78 ' 1/U G� I'( $ s7�- <br /> Mailing Address � � <br /> Name of Applicant /'O y A/6 2 <br /> Signature / i Date /U /Z J <br /> Mailing Address 4 /1 141 V 7k S 110/C 6P Lo 67 - <br /> Contractor J: e Go1 5Itu c.t/D /v LING= /%,1/k S gkil tx 7 <br /> A driveway construction plan and erosion control plan will be <br /> presented to the Town Board by /0 - ` 07 <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) 7O(' fir <br /> Application fee $ got), 00 0, <br /> Date fee received / <br /> (over) <br />