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^I �' <br /> yq ' <br /> Town of Vermont <br /> 4017 County Road JJ, Black Earth, WI 53515 <br /> Phone: (608)767-2457 Fax: (608)767-2555 <br /> Driveway Construction Permit and Inspection Application <br /> Part 2: Board Approval of Permit <br /> 1. An Engineering plan is is not equired (Planning Commission Chair to circle one). <br /> 2. The Vermont Town Boar. approve• disapproved this application <br /> (Town Chair to circle one •,-'. .e ow) <br /> Signature:9 Ai A ... .>�� Date: I - /y— 0 8' <br /> Note to Applicant: Driveway must be completed and receive final inspection <br /> within two years of Board approval date or permit renewal will be required. <br /> Part 3: Inspection of Completed Driveway <br /> XDriveway was constructed in accordance with the plan approved by <br /> the Town Board <br /> Driveway is not acceptable <br /> Applicant will make required improvements by (date) <br /> Comments <br /> Signatures of Town Bo rd Dr' ewa ommittee: <br /> Signature: Date: 6- $-09" <br /> Signature: C A a; n roico,,,J o 7' V ,6 4.'J Date: <br /> Town of Vermont Driveway Permit Application Page 2 of 2 Revised 8/28/06 <br />