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Permit Approval by Permitting Authority / '. <br /> The foregoing application is hereby approved and permit issued by the Permitting Authority subject to full <br /> compliance by the Applicant with all provisions and conditions stated herein and all attachments hereto. <br /> Federal Aid has been,or is being,used on this highway;current State of Wisconsin policy for <br /> accommodation of utilities on highway rights-of-way applies. <br /> f. $1550.Permit fee applies(escrow$1500. for road damage that may occur;returnable to Applicant if no <br /> damages occur);($50. for the siting fee;non returnable) <br /> Other Special Provisions: <br /> 1. Aillitif le Title u <br /> re of Au - ed '°" : mg Authori III' -.- tative / <br /> Date <br /> 2. <br /> Title <br /> Signature of Authorized Permitting Authority Representative <br /> Date <br /> 3. <br /> Title <br /> Signature of Authorized Permitting Authority Representative <br /> Date <br /> Driveway Permit Receipt <br /> Name 3 in in t 1 <br /> Address ye- (,Lf}kysOU <br /> //744SiMiL1 tar 6"351 <br /> Building Address Site I or J leek Cer- RDA) <br /> Phone (home) ao <br /> (poSf :345`--/le 3 <br /> Amount escrowed $ / z . --- <br /> Administrative/Inspection fee $ 3O, — <br /> Repair of Road Damage $ <br /> Amount Returned $ <br /> Return of Escrowed Fee $ <br /> Occupancy Permit issued on by <br /> Administrative/Inspection fee $ <br /> Repair of Road Damage $ <br /> Amount Returned $ <br /> Business Office Signature Date <br /> Copy for applicant Copy for office <br /> DRWAY Permit Procedure Rev 4/16/15 5 <br />