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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 /> f51550. Permit fee applies(escrow S1500. for road damage that may occur: returnable to Applicant if no <br /> damages occur); (S50. for the siting fee; non returnable) <br /> Other Special Provisions: <br /> 1. 7 Title - f/� � <br /> b -lied Permitting Aut orit Representative <br /> Si�(n re of At h 1 P � ��� <br /> Date `l <br /> -. <br /> Title <br /> Signature of Authorized Permitting Authority Representative <br /> Date <br /> 3. Title <br /> Signature of Authorized Permitting Authority Representative <br /> Date <br /> Driveway Permit Receipt <br /> Name -714-e_7- AcNe3 3 Le 6Jo.fL,bta_S <br /> Address p4.5 /21 Po : /OS <br /> lAr,661_C T'v - , -1-01,-- 535-(Q 2 <br /> Building Address Site 1,--Q*fr j ‘,7, 6J Ofd-CGS &IV (-+ - <br /> Phone (home) (work) 42°8 - .5� i - "7"Y"Aa, <br /> Amount escrowed $ 6 D , —`' <br /> Administrative/Inspection fee $ SO. ^°• <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 4,16115 5 <br />