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-.44 II r Y SOP / r tC_t�^/f cl/� V Circle One: New Construction Impro +ement (see page 1 for explanation) Permit Reinstatement Part 2: Application for Permit:The undersigned hereby applies for a permit to construct a driveway in the Town of Vermont, Dane County,Wisconsin. The driveway will be in Section 3 f). of tree Town of Vermont, f, Enterin To r County Road or State Hi hwa i a ►"t etc% b 1 Y g � � � G1 Y1 '�4 r ��c9 y'"Y 1'` �Ge�C� J Through property owned by: Name of Property Owner: � _I Z° CJ e. 1,1 I., /",k Y1'\ •Q Signature:.,--. 7 _..-' �:�...._ Date: / �2 -2 2 -26 1 L r Mailing Address: • .S 4.� v<±� , L <4(.*:-.,e4 U.1. . 3 3 g __ ..f.._ii r r is / Phone: 6 o.:79. - 7 C1-33'# 3 . Email: o/ /r c.,G ks.i x 7'c�t .5 • let ci-- Name of Applicant: Signature: Date: Mailing Address: Phone: Email: Contractor: .l ii.y A driveway construction plan and erosion contro plan will be required for new driveway construction.An engineer plan may be required. Does the applicant desire to use material from t e excavation of the house site to provide fill for the proposed driveway? h 6 . If"yes", an excavation p-rmit must be obtained from the Town Building Inspector. Proposed driveway length in feet: / Application&Fee Received by: Date: / —s-/J Driveway Constructi n Permit and Inspection Application Part 3: Board Approval of Permit 1.An Engineering plan is is not required (Planning Commission Chair to circle one). 2.The Vermont Town Board - approved disapproved this application (Town air to circle one a = '•,• •- Signatu -:%�/ ♦.%l tsi 4I .ri 1 4I / Date: �Q1►1 la lac31 Permit e sires: Date: % _t G 4IP qb\ • Note to Applicant: Driveway must be compl:ted and receive final inspection within THREE years of Board approval date or either a permit "EINSTATEMENT or a new permit will be required. Town of Vermont Driveway Permit Application Page 2 of 3 Revised 4/29/2013