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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 oi< of the Town of— � <br /> Blue Mounds, off Hwy or Town Road 8�9 ii-,-V7 � <br /> , through the property owned by: <br /> i <br /> Name of Property Owner <br /> �ic� Z .s&ii.ey yeP--• <br /> Signature Date )-��p_/✓ <br /> Mailing Address �/.5 L/�- %001-/ <br /> 7- 535222-- <br /> C L h � /� <br /> Name of Applicant �A� � � ������pp � <br /> Signature Date P0'.--/C <br /> Mailing Address d s L /e-i d Jr W <br /> M-. 0 h � Gtr— , S�. <br /> Contractor <br /> A driveway construction plan and erosion control plan will be <br /> presented to the Town Board by <br /> Does applicant desire to use material from the excavation of the <br /> house s ' e to provide fill for the proposed driveway? <br /> NO YES (If "yes", an excavation permit must <br /> be obtained from Town Chairperson. <br /> �j J / <br /> Proposed driveway length (in feet) ✓ 25 �`'�" /nQ <br /> g <br /> Application fee ' $ —Ida 00 _d <br /> Date fee received 31/ `E' //'' <br /> (over) <br />