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Application for Permit to Perform Work Within
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Highway / Road Right-of Way in the Town of Navarino
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| Town of Navarino,Shawano County,WI |
Date |
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| I hereby request permission to construct 1
Driveway 2
Driveways (circle one) |
| Purpose of this request |
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| Location is within the following described highway / road right-of way |
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| Road |
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Section |
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Township |
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Range |
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| East |
West |
North |
South |
Side of road
circle one |
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| Location of work with respect to road or other landmark |
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| In the performance of this work I will observe the precations and conditions |
| as may be set forth in the permit issued by the Town of Navarino |
| Special Conditions |
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| Approved |
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Signature |
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| Denied |
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Print Name |
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| Date |
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Mailing Address |
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City,State,Zip |
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| Signature of Town Board Offical |
Telephone |
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| Driveway to be installed by |
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Phone |
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| Note: Please set out a stake or flag
identifying each side of proposed work. |
| Describe completely the work for which the permit is requested. Two copies of
this |
| request form should be completed and given to one of the town board members |
| prior to beginning any work. |
| Navarino Town Board Members |
| Chairman Kevin Conradt |
Supervisor Jim Johnson |
Supervisor Steve Schinke |
| 715-758-8728 |
715-758-8134 |
715-758-8392 |