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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 /> /�15j0. Permit fee applies(escrow S1500. for road damage that may occur:returnable to Applicant if no <br /> �/ damages occur): (550.for the siting fee: non returnable) <br /> Other Special Provisions: Iff' <br /> °% Title <br /> ����� / P— ' k)(M AP) <br /> Stgna, re of Auto• zed Pe ng.Authgfi 'epresentative <br /> Date 3-a7 / <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 <br /> .__--- , rte <br /> � C.L STL0 <br /> Address •?l tto i /`f fiW w i d E - b 4,D <br /> Building Address Site Z-0-r doss P 'A0 <br /> Phone <br /> 82•`10 (work) <br /> Amount escrowed $ /,S�Q <br /> Administrative/Inspection fee $ 5O. <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 />