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Estimated Starting Date Q.-7 i Estimated Completion Date 3_ / —/ - <br /> Notify the Town Office at 8337-6688 when project is completed. <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 /> $2,050. Permit fee applies(escrow$2,000. for road damage that may occur; returnable to Applicant if no <br /> • damages occur); ($50. for the siting fee; non returnable)The Town requires the Owner and Contractor(s) <br /> initial that they have read and understand these terms. <br /> Owner ixb Contractor(s) <br /> Other Special Provisions: <br /> 1. j ?LL) Title ..e)t IL.� <br /> Signature of Au rized Permitting Autho ty Representative <br /> Date Y//b/il <br /> 2. ` <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 Or /l/(.�4 - D"77a leg <br /> Address 98 tkheiAlif <br /> mil �'voj, Li) <br /> Building Address Site kaP-e0Or <br /> Phone (home) 9 - , j).. (p1 vork) <br /> Amount escrowed $ a 0 DO- <br /> Administrative/Inspection fee $ , --"--a ' <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 /> DRWAY Permit Procedure_Rev2017 Revision Approved 3%13/2017 <br /> 5 <br />