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TOWN OF BLUE MOUNDS <br /> DANE COUNTY, WISCONSIN <br /> DRIVEWAY CONSTRUCTION APPLICATION, <br /> PERMIT AND Ii4SPECTION 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 Ol of the Town of <br /> Blue Mounds, off Hwy ox` Town Road . ex43tr■ <br /> , through the property owned y: <br /> h �/v`t� <br /> Name of Property Owner � , e.1, 1n. <br /> Signature Date 5/ / /200 ct <br /> Mailing Address -1 0 a S O V 4--k e <br /> 0 u k% 144brei3 G.N i_ c3s <br /> . Name of Applicant -eke_ <br /> Signature Date <br /> S/,/x 069 <br /> Mailing Address Jo v�"� rs,J'` <br /> fount u3 .r 3-35-72 <br /> Contractor <br /> A driveway construction plan and erosion control plan will be <br /> presented to the Town Board by 75(...A/ 3 O1 9-0 o9 <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) 00 <br /> Application fee $ �O <br /> Date fee received <br /> (over) <br />