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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 /> /1550.Permit fee applies(escrow$1500. for road damage that may occur;returnable to Applicant if no <br /> 1/_ damages occur);($50. for the siting fee;non returnable) <br /> Other Special Provisions: <br /> 1. 0* 1 2 Title J0/21W-4eA <br /> Signature of ininfg+AuUwt y epee *alive <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 /44'l?i#J( <br /> Address /4 ciao. 4 ' <br /> zdautalet r 53597 <br /> Building Address Site sL)r 19 <br /> Phone (home) (work) Zen/Y. - /Tii <br /> Amount escrowed $ /TOO- <br /> Administrative/Inspection fee . <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 4116115 5 <br />