STATE OF WISCONSIN
Town of ________
________ County
To the County Board of ________ County, Wisconsin:
The Town Board of the Town of ________, ________ County, Wisconsin, applies for fund entitlement under
s. 84.18, Wis. stats., to [reconstruct or rehabilitate] a seriously deteriorating local bridge in the Town of ________ located on ________ [give highway name, or otherwise describe] in the County of ________, district ________, and bridge number ________, of construction type ________. The type of work required is [describe as required by Dept. of Transportation] and the estimated total funds required is $________.
Dated this ______ day of ________, 20__.
[Signatures of town board]
Attest: [Signature of town clerk]
Note: For additional information see the Department of Transportation website at the following address:
