STATE OF WISCONSIN
Town of ________
________ County
TOWN OF ________ PERMIT
The Town Board of the Town of ________, ________ County, Wisconsin, authorizes and issues to ________ ________, as owner or operator of ________ [describe vehicle], a permit effective ________ ___, 20__, authorizing travel by the described vehicle on the following Town of ________ town highway in the Town of ________ on the following conditions: [list highways, applicable conditions, and the effective term of the permit].
A. The Town of ________ highways and routes that may be used under this permit are as follows: [list highways, routes, and specific locations].
B. [Choose Alternative 1 or 2 below, as applicable.]
(Alternative 1) The permit issued is a single trip permit issued under
s. 348.26, Wis. stats.
(Alternative 2) The permit issued is [choose one an annual or consecutive month or multiple] trip permit issued under
s. 348.27, Wis. stats., which shall be in effect from ________ ___, 20 __, to ________ ___, 20__.
C. The permit, as issued, applies only to the above-described vehicle during operations as permitted. The permit, as issued, is not transferable, is revocable, and can be suspended by the town board or its designees at any time for good cause. The permitee may upon revocation or suspension request a hearing before the Town Board of the Town of ________.
D. The fee for the permit is $_____ payable to the town treasurer of the Town of ________ by the applicant on or before issuance of the permit by the town board.
Issued this ________ day of ________, 20__.
[Signatures of town board]
Attest: [Signature of town clerk]
