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. 03/30/2000 19:50 6007672072 MICHAELSCERAMICSTUDI PAGE 02 <br /> yftviajtk <br /> d '. <br /> Town of Vermont <br /> 4017 County Road JJ, Black Earth, WI 53515 <br /> Phone: (608)787-2457 Fax: (808)767-2555 <br /> Driveway Construction Permit and Inspection Application <br /> Part 2: Board Approval of Permit <br /> 1 An Engineering plan is 15 required (Planning Commission Chair to circle one). <br /> 2 The Vermont Town Boa , approved 'disapproved this application <br /> (Towle Chair to eon • ow) <br /> Stgnatr: AAK. <br /> Note to Applicant: Driveway must be completed and receive final Inspection <br /> within two years of Board approval date or permit renewal will be required. <br /> Part 3: Inspection of Completed Driveway <br /> Driveway was constructed in accordance with the plan approved by <br /> the Town Board <br /> Driveway is not acceptable <br /> Applicant will make required improvements by (date) <br /> Comments <br /> F • <br /> Signatures of Town Board Driveway Committee. <br /> Signature: Dale: <br /> Signature; Date: <br /> Town oI Vsmbri Drivel/Ay Permit Application Pepe 2 of Revised 8/24,08 <br />