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AKNOWLEDGEMENT: <br /> As owner of the above named prope I agree to all terms, conditions, and specifications <br /> outlined in the above permit and in the Town of Albion's Driveway and Culverts Ordinance. I <br /> also acknowledge and agree that I am esponsible for any damage to the roadway, shoulder or <br /> right-of-way, which occurs during the construction process, up to and including any time period <br /> until an occupancy permit and/or final inspection notice from the Town of Albion Building <br /> Inspector is issued and received by the Town. I agree that the damage deposit of$2500.00 I <br /> make will be retained until the Town toard acts to release the deposit. Costs for any damage, <br /> solely determined by the Town, will br deducted from the deposit prior to return. <br /> 'e..7,1)15414.V2 ,5"7Y° a <br /> Property Owner Signature Date <br /> Approval of initial access J� ' ;r .5-12-20M, <br /> T r,wn Repre -ntative Date <br /> Access granted/denied by the Town B.and on: ,6 -'7- , 20 /L <br /> Reason for denial NI/',A <br /> Deposit amount: '3'259J °b Type: y/ personal check(f (2S,r 644571ectGTIoJJ LL L) <br /> money order/cashier's check * t 44 3 . <br /> Date deposit authorized to be returned •y: Public Works Staff: <br /> Town Board: <br /> Date deposit authorized to be held by T.wn Board: <br /> Date deposit returned by Clerk/Treasur,r: <br /> Comments: <br /> C:\Users\Albion\Documents\Driveways\DRIVEWAY APP [CATION&PERMIT I-1-2016.docx 4 <br /> 4/24/06 <br />