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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 compliance <br /> 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 accommodation <br /> 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 Provisions: <br /> 1. �Li—i G( _ t.C�Ut Title 642d-id-tie <br /> Signature of Authorized Pe itting Authority Rep csentative <br /> Date '/23 / / <br /> 7 1 <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 Lv,R. r. / 3Tb <br /> Address 'Q 7-4- ka Kk <br /> CfftrA LptC 44 Dl/E, <br /> Building Address Site 7101 CYZ4i W V <br /> Phone (home) ,r,3 Da - (p 1,3p, (work) - q g)''.j <br /> Amount escrowed $ /±JD t. — <br /> Administrative/Inspection fee $ S0, <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 $ l <br /> Business Office Signature ny_ ,&- 21 Date /—a — 1 1 <br /> Copy for applicant i Copy for office <br /> DRWAY Permit Procedure.doc Rev 4 16.15 5 <br />