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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 /> Wisconsin. The driveway will be in Section 20 of the Town of <br /> Blue Mounds, off Hwy or Town Road Blue Mounds Rd <br /> , through the property owned by: <br /> Name of Property Owner Andy and Kristin Davis <br /> Signature . Date /67/2 /. <br /> p <br /> Mailing Address 721 up.Mounds / r <br /> Mount Horeb WI 53572 <br /> Name of Applicant DPrekcarpentar <br /> W4819 Pembridge Tr <br /> Signature Monroe WI 53566 Date id-01 CO <br /> Home Design Solutions Inc <br /> Mailing Address <br /> Contractor <br /> A driveway construction plan and erosion control plan will be <br /> presented to the Town Board by <br /> Does applicant desire to use material from the excavation of the <br /> house site to provide fill for the proposed driveway? <br /> __x. NO YES (If "yes", an excavation permit must <br /> be obtained from Town Chairperson. <br /> Proposed driveway length (in feet) _120ft <br /> Application fee $ .g(() n(2 <br /> Date fee received <br /> (over) <br />