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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 /> Q <br /> Wisconsin. The driveway will be in Section ' Q.. of the Town of <br /> Blue Mounds, off Hwy E or Town Road --- <br /> , through the property owned by <br /> Name of property owner .bnya d - A1'1 Pta. RlLhde H •• <br /> Signature gd4L-caCi^406� Date °� 09 <br /> Mailing Address P.CS' 'O�c 1'"'►_ <br /> Mthovv 4 5ats`i <br /> Name of Applicant cA%as e, {`l,l.nGv ,, ff <br /> Signature ` A' 1,,,. �Gd� Date ��`t j Q 9 <br /> Mailing Address i'.s . (Soy_ <br /> IMP nTh►np, . A <br /> Contractor ■04. W V19kVLV'hOn <br /> V er6ci <br /> lr erg theeXt <br /> A driveway construction plan and erosion6ontrollan will be <br /> presented to the Town Board by Toed 1-�o.tveA5l.ebee,, pe <br /> Vierb"e.her q►n2evrt,nq <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) 4 et4-- (Ci log <br /> �,Q <br /> Application fee $ gOOI 00 -49d 7/' <br /> Date fee received <br /> (over) <br /> • <br />