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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 /> 550. 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. Title <br /> Signat 'ofAuthoriz.. 'emitting Au•ority Representative <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 K Lff.Z it..,Oa <br /> Address 401?11455 A,- t ) t( <br /> 5MA-&)i)A-lk 144-11,E9 <br /> Building Address Site lr <br /> Phone (home) (y012) • 0111 1{5 rk) <br /> Amount escrowed $ 1502`). — <br /> Administrative/Inspection fee $ +5-0 <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 /> DRW AY Permit Procedure Rev 4/16/15 5 <br />