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•,(0 : fite 0 f- A L 13;0 isi 1141 :41 i 201 7 7
<br /> A.k.1,10W .EDGEmvii,..;-1:
<br /> A,owner oi the above named properly I agree to all te4".M.S.conditions,And specifieations
<br /> outlhied la Me above permit arid in the Town of Albion's Driveway and Culverts Orciihance I
<br /> also acknowledge and agree that T am responsible for any damage to the roadway,shoulder or
<br /> right-of-way which or.'t rs during the struction 1.-)rocess,up to and including any time period
<br /> tmtil a' occupancy permit andlor final inspe.setion 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 Board acts to release the deposit. Costs for any damage,
<br /> 3olely drAonnined.by the Town, will be deducted from the deposit prior to return.
<br /> r}rherty 0 - r Signature ---- Date
<br /> e-",,..1 4-.3-Zvii
<br /> Alpproval of initial access Aea-V' 4./
<br /> 1 OW fl Representative Date
<br /> -- - _
<br /> ".„.....v__
<br /> Access(g,rante-T' ' by the Town Board on: Wij i ,20
<br /> r i
<br /> Reason for denial
<br /> ,.,.,
<br /> f i ,
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<br /> Deposit amount firopo.'=i- ... ...... type: X personal cheek -f-r-,"
<br /> ),..,,,,4;04.,....“ (2. _tt, 5 o .. i.,:i.,&, /;Li s ______... momy ordcricashit-,r's timck
<br /> Date deposijautborized to be reiurned by: Public Works Staff:
<br /> Town Board:
<br /> Date deposit authorized to be iltrid by Town Board:
<br /> Date deposit returned by Clerkflreasurer:
<br /> Comments:
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