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ermit 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 /> ccommodation of utilities on highway rights-of-way applies. <br /> $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 /> I. OtrAPIr. Tiller Signature o.Amining Authorit Re entative Date <br /> P/41/5" <br /> 2. <br /> Title <br /> Signature of Authorized PermittingAuthorityItepresattau e_..� <br /> Date <br /> 3. <br /> Title <br /> Signature of Authonaad Permitting Authority Repr motive <br /> Date <br /> Driveway Permit Receipt <br /> Name !tI✓ y,�r%i`.,)' <br /> Address tsii� '4ee,Pf <br /> Building Address Site ck-44"/I)� <br /> Phone (home) 6O ,517 C GQe4work) <br /> Amount escrowed $ 1509, -- <br /> Administrative/Inspection fee $ --- <br /> Repair of Road Damage $ . <br /> Amount Returned $ <br /> Return of Escrowed lee $ <br /> Occupancy Permit issued on by <br /> Administrative/Inspection fee $ <br /> Repair of Road Damage $ <br /> Amount Returned $ <br /> Business Office Signature Ai a L. P/1 ,Date /1- — <br /> Copy for appl‘i C u or office <br /> DRWAY Permit Procedure Rev ki61 1S <br />