Laserfiche WebLink
• <br /> AKNOWLEDGEMENT: k <br /> As owner of the above named property I agree to all terms, conditions, and specifications <br /> outlined in the above permit and in the Town of Albion's Driveway and Culverts Ordinance. I <br /> also acknowledge and agree that I am responsible for any damage to the roadway,shoulder� or <br /> right-of-way,which occurs during the construction process,up to and including any time period <br /> until an occupancy permit and/or final inspection 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 /> solely determined by the Town, will be deducted from the deposit prior to return. <br /> 4,!-/ 47'144, / 3 Date E / <br /> Property Ow r Sign ature <br /> Approval of initial access ei tgai- = '1 3/2//f_O/g <br /> own Repres ntahve Date <br /> C <br /> Access granted/denied by the Town Board on: , 20 <br /> Reason for denial <br /> Deposit amount: Type: personal check <br /> money order/cashier's check <br /> Date deposit authorized to be returned by: Public Works Staff: <br /> Town Board: <br /> Date deposit authorized to be held by Town Board: <br /> Date deposit returned by Clerk/Treasurer: <br /> Comments: <br /> C.'Users\Albion\Documents\Driveways\DRIVEWAY APPLICATION&PERMIT 1-1-20I6.docx 4 <br /> 4/24106 <br />