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From:TOWN OF ALBION 05/23/2016 09: 16 #635 P.004/004 <br /> AKNOWLEDGEMENT: <br /> As owner of the above named property I gree to all terms, conditions, and specifications <br /> outlined in the above permit and in the T wn of Albion's Driveway and Culverts Ordinance, I <br /> also acknowledge and agree that I am res onsible for any damage to the roadway, shoulder or <br /> right-of-way,which occurs during the co struction process,up to and including any time period <br /> until an occupancy permit and/or final in pection notice from the Town of Albion Building <br /> Inspector is issued and received by the T wn. I agree that the damage deposit of$2500.00 I <br /> make will be retained until the Town Bo d acts to release the deposit. Costs for any damage, <br /> solely determined by the Town, will be deducted from the deposit prior to return. <br /> 3-- l (e. <br /> Property Owner Signature Date <br /> Approval of initial access fildialajetbA) 3-2,g-2.014, <br /> Town Repre ntative Date <br /> • <br /> Access granted/denied by the Town Board on: , 20_ <br /> Reason for denial <br /> Deposit amount: Type: personal check <br /> money order/cashier's check <br /> Date deposit authorized to be returned by: Public Works Staff: <br /> Town Board: <br /> Date deposit authorized to be held by Town Board: <br /> Date deposit returned by Clerk/Treasurer: <br /> Comments: <br /> C:\Users\Albion\Documents\Driveways\DRIVEWAY APPLICATION&PERMIT 1-1-2016.docx 4 <br /> 4/24/06 <br />