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From:Bjom Vogen Fax:(866)442-�1D8 To: Fax: +1 (952j^_49-4616 Page 2 of 3 07l1512015 3:52 PM <br /> ---- C i C T 5�U14LY-- ¢Q� <br /> i���_t},'t�f�,� City ofOrouo UateR�c�itie��� 1'�rmii����� O o <br /> - i�'.U�&�x 66 "f'�� <br /> � i� � 2750 K�lie�YrukG+ay [�in-Eirsuse SAC'1"Jcfarmtn�tic}n F orm C.ompleied <br /> � 4� �� Crystalti3rv',MIv'S�323 � � <br /> '�' �,;r; C1S217 iJ-4Gt:ki/t ax(,952)249-461Ei Apprtiveti 13�,'(Tf[r�c{wrct9}�. _ � -- — <br /> ,,;,< i f <br /> C"IT'k'OF ORCD?VQ-S�'1��;R&V4'ATER/GENER"T "`�- <br /> ('Note:Sume perm,it:sr7as'reyuire 7}�pto�'al h,y ihc£iuildiug Of�licial ancVor Yi.hlic <br /> (41 i PERM79'S- Ma�Ire su1>iect Ct�furiher raview ahtl nzaV not 6e f�cued nheu t} ���� <br /> ��r�E�c, l�r€�o���riaiv _____ n !� ! �r���/� <br /> � . � <br /> 3. Yc�u may apply for utilii'y permits by ui�il ar in person at zhe City offic <br /> 2. �vlailec{in a�plications are subje;ct to the�ostage a�7d ha��dii��g fez;sho� { <br /> be sent by return tnail within 2 busine��ti days. d <br /> 3_ Pe►•mits are�at r�atid until you e�eceive a pe.rrnit eard. <br /> 4. ZVork must nat b�gin ui�less t��e pernxit carci is xx�ailable on the job site. �,, 1 � ����� <br /> 5. C�ti(iry conneetion permita ina�y=be issuec�eo l.icensed contractors only. l� (fV <br /> C. C;ontact tl�e i'ublic�Works D��parCment{952-2�1�-G600)far utitity stub as <br /> llCl NE`1T�ReAVA"CE IN ANY ST'EiEE'C Al'rdD DO Itit)'7''�`�1,P ANY <br /> a��provai of'ttse Pubiic Works Depa�Kment. lssrta�ice of�permit does <br /> 7 All�vork musi be dorie ia accordance with State C�de requirements. <br /> $. All w�rk mnst be inspected before it is c�overcd. Catl(�52}249-4600,l4 <br /> - ---r____..______ _- - --______._��. <br /> (- ---_._�___._ ���or ��;�tvr��r <br /> Lc�,���;����7,�t a����.���____ <br /> �.sideiatial(May ftec�uire Approval) ❑Commercia((Apprawal:Rc��wreq) <br /> ❑New Connection ❑gdditional Cannection ( � e-Connection ��airs ❑1Jiscannect <br /> ❑ �ater Availability C.on ection Pvr Future�-ir�o -CIp to Water <br /> Job SiTe �O�vner Infc�nnatinz�: <br /> - _ _— __ _ � <br /> Site Address: ,�'���'} � ���i� �i�kM��..,� c��"��:�:� <br /> C)�,>�ler:��F��,. �Pa. �� �'���, �'(�tilin;Adclress: ����� +...c`'�i,.�l.�117�4r\ �-�Y£'.�� <br /> Gity: ��"�t"1 -- ��l� ;'�'J �� � <br /> t�iome Phane: �lte�late�'I�an�: _�._ <br /> ,��Co��trackor InfocznaCi�n � -- -- -�-j <br /> ,� __ - � �- ,�y' <br /> Cor�tractor� C;��,���,�,,� Cantact Persos�: ��_� _-���;!� <br /> t „�y���- - --� <br /> �1_1 _ �,7 j} <br /> Address: ���.��� �J..-��%�.�,����_ State License#: . "�:� � f�f�� <br /> f �� ��" <br /> CiCy; �..�v�s.��1r�-- Z�P�___.�_���fl�xpiraUo�i C)ate; `'� ------ <br /> 7 ,� ���<:���i�, �� 7 <br /> F Itane: ���7 �-����� -� ,glt�;r�late Pt�onc: �� �_ ____ <br /> �, <br />