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et Address: Mailing Address: Phone: 952-249-4600 <br />) Kelley Parkway P.O. Box 66 Fax: 952-249-4616 <br />io, MN 55356 Crystal Bay, MN 55323-0066 Website: www.ci.orono.mn <br />Right -of Way PermUA pp. Ication <br />Purpose for Construction: New ❑ <br />Facility Owner: _f p_1 6tJ MAVC-VtC 45 <br />Contractor: 0 I. -C"ez 40me <br />Contact Person: (Zfz(S,(� t4L.0 j4 ' %�o IA <br />Billing Address: 6L41 F- lAu(F 5`t' iee 1 *' z23 <br />City: W A44 7_ AT'>llr <br />State: M v-1 Zip: 553 cl t <br />Permit Type: Excavation ❑ Obstruction ❑ <br />Replacement X Repair ❑ <br />Maintenance ❑ <br />Project # JlmVoc4F-M4L<96144M.Cagy <br />Phone #: 61 Z 2-28 o 2 27 <br />Cell Phone: 6t7_ 70l Ysg <br />Email: <br />Construction Location: P t 6l-tl 6� UJA,M - D Q wFi W A <br />(Attach plan/sketch of proposed construction) <br />Nearest Intersection: n Ln t„p t -'r6 `A,.,zE <br />Excavation Size: Width: <br />Excavation Type: Trench ❑ <br />Driveways ❑ <br />Length: <br />Hole ❑ <br />Cabinet ❑ <br />Depth: <br />Plow ❑ Pneumagopher ❑ <br />Pedestal ❑ Other ❑ <br />Specify Other:*" "0TC G4M tuff- k--IC-A0 9-t A A Rot-� WO <br />Nr '0V Oe_isiC . -'AJ" A p 0lza�/ o I A:$ <br />Obstruction Information: 9C-QUiQe-& "1?tt�-a�G-� E��rN��,�QrN� A.pQ1bV+AL <br />List the portion of the R -O -W being obstructed: <br />Obstruction Size: Width: Length: <br />Hours of Obstruction: Start Date: at <br />Construction Schedule: <br />Start Date: <br />Weekend Dates: <br />AM to End Date: <br />Number of Days: <br />End Date: <br />Depth: <br />at PM <br />By signing this document, I (the applicant) hereby state that the above information is correct and may be subject <br />to change. If a change in any of the above information occurs, I (the applicant) will inform the local municipality <br />for proper approval. Please send the completed permit application to: P.O. Box 66, Crystal Bay, MN 55323. <br />Applicant Signature: a e: /V (y"I'Z018 <br />Municipality Signature: <br />Date: <br />RECEIVED <br />MAR 14 2018 <br />CITY OF ORONO <br />