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6088254864 Village of Sun Prairie 11:33:54 a.m. 06-30-2016 2/3 <br /> 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 /> damages occur);($50.for the siting fee;non returnable) <br /> Other Special Provision : <br /> 1. Title /5‘ <br /> �3 v <br /> i cure of Permitting Authority Representative <br /> T ` <br /> Date C/0 //4 <br /> 2. <br /> Title <br /> Signature of Authorized Permitting Authority Representative <br /> Date <br /> 3. <br /> Title <br /> Signature ofAuthorized Permitting Authority Representative <br /> Date <br /> Driveway Permit Receipt <br /> Name <br /> Address <br /> Building Address Site <br /> Phone (home) (work) <br /> Amount escrowed $ <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.doc Rev 4/16/15 5 <br />