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C:',Ircie One: New Construf.:tif.yi 'I-see <br /> Part 2: Application for Perqiit: Le uncle-signed hereby appiie-,s for E., io ruct <br /> Town of Vermont, Dane County.Wisconsin. <br /> The driveway will be in Section 3 I _of;Ile Town of Vermont, <br /> Entering Town or County Road or State <br /> Through property owned i2y: <br /> carne of Property Owner: . <br /> A • '•• ' <br /> Signature: o'. . Data. <br /> Iviailinc Address: — <br /> Phone: <br /> Name of Applicant: – akt i ki r j h VI <br /> Signature: \‘..1111111111.111111M44. Date: <br /> Mailing Acidiess: g' <br /> ross Pla 5:35d-a <br /> Phone: eoos /-47er 7oo ...Seh Cr-)t 1-1 yQ 400ce A.7 <br /> Contractor: B u,(Ider 5 <br /> A driveway construction plan and erosion conIrol pri he re.coired driveway oons'ir,ict:on A enain, r <br /> plan may be required. <br /> Does the a.pplicailt desire to us z]; matc:-i.al from the excavation c te ouse sito o vkie fili r the <br /> driveway? Al 0 If"'yes", an excavation permit Must be obtained from the Town Building inspector. <br /> Proposed driveway length in feet: _ <br /> Application & Fee Receiv.it-3 by: 7)31*e: <br /> Driveway Construction -ertntt anc, inspection ikppiicaiion <br /> Part 3: Board Approval of Permit <br /> ngneeriog paI is 14IM CoMrrissici-i Chair to Gird c,net. <br /> 2.The Vermont Town Board a Drov riisapprovi <br /> :Town Chair to circle one ail s:gr. oeic <br /> Signature: <br /> Permit expires: Date: <br /> Note to Applicant: Driveway must be conipleted and receive fina; .I'ic,pection within THREE yea ; a 3.73a7r!, <br /> approval date or either e permit REINSTATEMENT Cr a new permit will be required. <br /> Town of\ferment Drive-rvay PeFrnit Applicatic:n Page 2 c." Revised 4129,20 1 3 <br />