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TOWN OF BLUE MOUNDS <br /> DANE COUNTY , W,SCONSIN <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 32- or the Town of <br /> Blue Mounds, off Hwy or Town Road pice y-rl /36-74,e y RoAo <br /> , tnrougn tne; property owned by <br /> Name cf Property Owner G <br /> Signature /' 4 ,7 <br /> Date 8-/C <br /> Mailing Address _ / 0 79-1 /V0/--.7 H er Y f 0,10 <br /> QL a /t c LAn.as, S3s-7z <br /> Name of Applicant (2 / '/ <br /> Signature .ecf�, � � - Date -/ ( /.1-- <br /> Mailing Address. /t 79.Y e7N /°£✓t'.y / vrgv <br /> r1) ",tips, I,4.1 I — 5T sy <br /> Contractor Q LA-'C ./ 8 c E ///y cam/ C.x c /9YA7 /A/& :-1%/c . <br /> A driveway construction plan and erosion control plan will be <br /> presented to the Town i'.oard u} -f C _ /S—_ . <br /> Does applicant desire to userr,aterial from the excavation of the <br /> noose site to provide ii . l proposed driveway? <br /> No ' YES Tf "yes" , an excavation permit must <br /> oe obtained from Town Chairperson . <br /> Proposed driveway length ( in Lee, �C <br /> Application fee ; .g( ) ()() <br /> Date fee received <br /> yr. <br /> 0. t <br /> over <br />