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.... ... v.. a. vvi ••.•.• a a r av +•+r+ .1vL& wisav. vvw�w..Va..p . ...a .. 1VvVI . r L ♦ VVL <br /> Town of Black Earth <br /> Driveway Application <br /> 767-2447 <br /> Date 374(70 9 <br /> Name <br /> Address PR, 1 bcdins ! 53591 <br /> 1 <br /> Phone Number / - 7 7 1� 57 6 - b 7S <br /> 4d /137 - 38/5 <br /> Please submit a drawing of your planned driveway. We will set <br /> up a time to do an inspection of the site. <br /> The above driveway has been approved for construction. <br /> Date <br /> Sion attire <br /> ;t, <br /> Contact again for final approval of driveway before starting <br /> construction on buildings. <br /> This permit needs to go to the building inspector to get a building <br /> permit. <br /> TO Building Inspector Town of Black Earth <br /> The above driveway has had final approval. <br /> Date <br /> Signature <br />