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<br /> -� Crystal Bay,MN 55323 ,:;.�`S?It�y.,z+,;;;;,;'",,';;ur"�::a;e%i'�;�i ��`!�"'��s;:"�;1i:?1;,;.;:�;.r,;:
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<br /> t (952)2a9-4640/Pax(952)249�616 ,'A,Ppr¢W�d;�Yr��. '�; ��; ':`•
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<br /> C�TY OF O�QNO-SEWER&WATE�t/GE�TERAL P�Y�MIT
<br /> (x Noce:So�e perznits may require approval by cb�e Buildiag Officiel and/or Public wozks Aepsrt�n�ent*)
<br /> (ALL PERI►2ITS- A'I�v be eubiect M furthar revkw and mav not be isaned when the anDllcatlon la received)
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<br /> 1. You may apply for utility permits by mail or in pez�san at the City offiees.
<br /> 2. Mai�ed iza ap��ications are subject to t�e postage and laandling fee show�a below. �ermit cards will
<br /> bc sent by return mail witlaiva 2 bus�iness days.
<br /> 3. �ermits are not vaGd an�tid you recefve a permit card.
<br /> 4. Woxl��ust not begin unless fh.e�ezuut card is available on the job site_
<br /> 5. U�ility connection pezxaazts zuay be issued to licensed contxactvzs o�ly.
<br /> 6. Co�tact t1�e Pub�ac Works Deparknent(952-249-46QQ)�or utitity stub as-built lvcat�o�as.
<br /> DO NOT EXCAVA'I'E IN AN�'S�'�.EET ANb DO N4T'x'.A�,�.ANY MAIN wlthout express
<br /> a�proval otf the�ablic Works Departmea� Issua.nce o�a pemut does not grant thxs appzoval_
<br /> 7. AlI work must be done iz�accrnrda�ace witkZ State Code requiremez�ts.
<br /> 8. All wrnrk x�aust be�nspected bEfore it is eovered. Ca11(9S2)249-4600,24+hour notiee rec�u��-ed.
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<br /> ]�Residen�ial(May Require Approval) �Co�uurnercial{Approval Requared)
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<br /> ❑New Couunectiou ❑Additional Connection ❑Re-Con�ection �Repairs ❑Discazun,ect
<br /> [� water,�A,vai�abi�Zty Coru,ec�ion For�ture Hook-Up to Wate�r
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<br /> Site.A,ddress: a Z 5�a.- Le,O QL.
<br /> Owner: ��✓� �+}�it't� Mailing.A,dd�ess: S�.wr _
<br /> City: �ro /�c� Zip:
<br /> Hv�me Pb�oz�e: d/a.- ,.S�Q ,'��,�5'.A.�tezx�ate�hone:
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<br /> Contractor: ar9�la� �Sor1S_��►K� Contact Persan: _7;�
<br /> Address: 3�i►!D �;Ir+tee- �.,,,�, �(/State L.xcex�se#: pG6�1�3d��
<br /> City: ��Jh Zip:� Ex�iration Date: !��3 ��/ �
<br /> Pha�.e: �d3- �7�•f���,� Alternate Phone:
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