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• <br /> TOWN OF BLUE MOUNDS <br /> DANE COUNTY, WISCONSIN <br /> • <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 3 of he Tpwn of <br /> Blue Mounds, off Hwy '16 or Town Road C 0 w )►AIL/ On o /32 t)C <br /> , through the property owned by: i <br /> Name of Property Owner L ���5� ‘derued 1 ‘d 114 e <br /> Signature Date 5-M7 <br /> Mailing Address /0/ y v to i i2 <br /> Name of Applicant <br /> ✓AC. G/i re/e 5s 4vt ) <br /> V <br /> PP <br /> Signature t� / f ,fDate <br /> ��/or <br /> Mailing Address �!L(' eht4-e-47r. 4-N <br /> ALA 3M 42/ 5.3777 <br /> Contractor <br /> has been <br /> A driveway construction plan and erosion control plan wilt-be- <br /> presented to the Town Board by J*G . <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) <br /> Application fee $ �0O <br /> Date fee received Z/ <br /> (over) <br />