Laserfiche WebLink
Applicat�on �or <br /> �_i���' O� ����►�)'i�� Utnlit� F'era�ti�s <br /> ��:vE�,L ztv�c�P.t+�ATzotv sevwer water we11 <br /> 1. Vou �nay apPlN 6ma uttL�ty penmite bu maiP ox 4n pelean at the City o5�<cea. <br /> 2. uailcd in appl4c.aLione arte eubjeci to the poetaqe and handCing 6eee ahown beCow. Pertm4t cande wi11 be eeni bu <br /> neturtn maiP ihe ea�ne day ihe appCication ta �eeceived. <br /> 3. PERH7TS ARE N07 VALID UNi'TL YOU RECEIUE A FfRMIi CARD. <br /> 4. 4�ORK MUST NOT BEGIN UNLESS THE PfRHIT CARP IS AVAiLABIf ON 7HE JOB S1TE. <br /> 5. uitftiy conneciion pertmite may be teaued to C(ceneed cenf�eaciorte enP�r. <br /> 6. Cnnfact the C4:iy o561cee �oa uLiLity etub aa-bu(£t [ocatlone. <br /> DC NOT FXl'AVA7E 1N ANV S7REET AND DO NOT 7AP ANY IIAIN withnut expneee appnevcl o� the Vublic Woake Uepaatment. <br /> ISSUANCE OF A �ERIUI' DOfS NOT GRAN7 7NIS APPROVAL. <br /> 7. ALL wORK MUS7 8E ?'ONE IN ACCORDA�;CE tU17H S7ATE CODE REQUIFEAIEN7S. <br /> a. AL[ wnak muet be �nepecZed be6oae ii ie caveRed. CaIL 173-1357. <br /> To aeau2e p-�nmp.t inepect<on, net<pu ti�e tnepectort beboae woak b�441E. <br /> I N S T;�Ul:,2'I UN� Complete aLC �teme on titie appltcaiion. Compute the pertmit bee. Stgn and date the celi<�{icatian. <br /> � � T!aC011PLE7E APPLiCA7I0NS W1CL NCT SE PROCESSED. Ib you have �ueetiona, caPf 473-735%. <br /> G1ALK- IN P�Rh4I7S At��p�y a� C��y CU�.�.ce�5 , 1335 Sou.tl� 8n.aw� Raad ( C��. Rd. 146 ) <br /> MAIL-IN P�Rh1ITS �ne�o.5e �ee - ti�a��. �:o = P. O . }3ax 6G , Cn��3�a� Bay, Mn. � 5323 <br /> JOB SITE ADDRESS ,�I y L� r�A1_�Lf_t� J�l� � 0��1?�IER (x2.D�'_n� ��i� ti:"rC.c= <br /> Oceupaneu Type� ___ R2a�deniial �( Comme2cia£ 0#hea: _ ____.___________ <br /> Eziet�na occupted building Neu• conet�cuction, net yez accupied <br /> Contractor� �`tc=4'i.=. n.� (��-����- � o Telephone No. y-7 `�/ -�� `/ r <br /> P•4ailing ?�ddress <br /> City License No. � _ Master Pluraber ' s State License No. <br /> PERMIT TYFE & FEE CALCULATION <br /> MUNICIPAL SEWER CONNECTION �32o.no pea .zub ptua S.so szaze su���,a1y� • S�o.so eaek) $ I'ermit <br /> p�p¢ size tinches; mate2iaf _PUC (�n eand p�l[1; _ ea.et thon; otheh ______ <br /> A4D FGR Mt�CC SAC CHARGE� 5425/urit X �� un<te � S��- <br /> SAC A141ST ACCONPANf' ALL SE0.'ER P�RMI7 AFPLICA7IOAIS unleee p2epa�d. Ib prtepn.id, ehaw 1e�enence Lo: <br /> �'zcr,pz ,Uu. Buieding Vertmit No. Gene2aC P2Rmt1 No. <br /> NOT�S: i; A eepanate peumbLng pe2mtt mubt be ob#a.ined (�oa any <.ne�de pPumbing changes. <br /> Z) Clzanouze muet be inbLaLte� at nighz angle b¢nde and evertu 150 6eet o,� 2un. <br /> 31 Ex�s.ttng cep.tic Lanke muai be pumped and 6iLLeC. <br /> MUNICIPAL WATER CONNECTION �Szo.oo neA 6xub plue 5.so staze Surtchange • STo.so ea�h� � Permit <br /> pipeiecze tnchee: mateaiaf eoppen, type _ ; orhe2 --------------- ----- <br /> ADD FCR WATER 11�7ER: 5/8" _ $6C.00; 3/4" _ $85.00 ME7ERS tAL'S7 BE PICKED tlY A7 CITV HALL. � Me t e r <br /> uOiES� 11 Meterte mau be purtchaeed by the contaaeto� ort by Lhe prtopertty owne2. <br /> 2) Uatert pelm�ta <nc£ude <:nepectlon bc,2 m¢t¢n cnatccLGat�on. A separtate pZumb�ng pertmit mueZ <br /> b¢ obta.ined bo-2 anu othert inaide peumbtng ehangea. <br /> 3) Cu2b e#op mua# be eet �°�u.eh Lo grtound ou2baee. <br /> Ij WA7ER NUS7 NOT BE 7URNED ON UNTIL Ci7S' SFALS WETER - CALL WHEN REAVY. <br /> � 3p.sv � <br /> PRIVAT� t�7ELL INSTALLATION is2o.00 ne1 �ob n1LLe S.so Siate Sunehange - -S�-o--sro eachl $ �b � �'e��ttit <br /> check: new Weee nepLacement we.LC nepairt ¢xieting weCG; caeing eize: Cnchee <br /> N07ES: 1) A eepanate pfumb.i.ng penmit muet be obtained 601 any <ne<de peumb<ng ehangea. � 3��' ��������`� <br /> 21 Requin¢d min.�mum ae.�.bncka, hrtom: dhain(�Ce�d - IS 6eet aept�c xan.k - SC he¢Z F/�,�- �N�, <br /> CALL FOR SI7E LOfA�iON 6EFORE DRILLING <br /> 3! Upon compt¢t�.on, CI7Y A1US7 BE SEN7 A COPY OF TNE S7A7E WELI RE�OR7 � <br /> State SUr'C�'13C�� 7he State BuiLding Cod¢ OivieioK Surtchnnge od SOS pe2 pert�it hae been �ncluded above. <br /> - 7oZal Suxchalge bon co�ibined wateR and eewe.n penn�cze <e 51.00 <br /> Postage �.17C� HdXlClling OK all walled-iK applteatione, add tht po�tage aed handling 6ee $�(� <br /> TOTAL PERMIT FEE �':�,�...::...''""�— <br /> The undenecyned h¢2eby appliee to Lhe City o� 02ene Fort ieauance o6 a 11711I7V PERMIT, agaeee Lo do aCL wortt� .in etaici <br />------__----a.ecaxdance wi.Sh the oadiaa-acee-o-�_th<_��tu.an�th�-��guCatcuae o{� the Siat¢ a� llinneeo.ta, and eenLi.��e:e-Lka.t-a�� _--- _ <br /> t#atenrexfa murle oR thia appYica#ion a�z com�+feYe, Zxue aR�t coan¢et. - "-" --" <br />