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Nov 13. 09 04: 34p p. l <br /> ! <br /> F R .f UtiF.ONI.Y ('�j� <br /> '" ��'�'•�,.. Lify U�ViUnO Dutc liwcrvcd�l��i��l'crmi�fl C��� a / <br /> �� ��\ 1'.U.liux GG �_ � <br /> �i`�w• �'' 275U Kdlcy I'urkwuy ❑In-Housc ti�G�k�crniinauon f�orm Complctud <br /> �"� '�I!�,r n ' � ('rystul li�y,MN 5532i <br /> \\ ii.,��� (VS2)2d9.a�,0(1 1lpproved fiy(11'Rey�i�ed1: .__, <br /> �aw . <br /> C���v Ur ORONO—SEwER& WATER/G�NE1tAL PEItMIT <br /> (Y Nm�;Somc rCrmil�may requirc.�ippruval by lhe I3uilding U(liciul unJ/or Public Works Lk:purlmen!°) <br /> (,nl,�l,['IiltMl'1'1- Vlav hc yubirct tu fu�ther revicw xnd mHy na lie icvued when t6�a�rliralion iv rcccivcif) <br /> GENERAL INPnRMATCON � <br /> !1. Y�iu mtly tipply lor utility permits hy mail nr in�ici:snn a[�hc C..ily o1�7�iccs. <br /> 2. ivls►ilecl in�p�licc�liuns are subject to thc postagc and ha�idling fcc shown bclow. Pcrmit cards will <br /> � be�ent by rclurn mail within 2 business d�ys, <br /> . Pcrmits nrc nqt vnlid u�►til yuu reeiive�perrnil curd. <br /> � Work must not hegin unless the perrnil.�►rd is f►vFiil�iblc un thc,job sil�. <br /> . lJtiliry connection p�rmils rn�y bc issucd tu liccnscd conUactors only. <br /> . Contact the Public W�rks Dcpar�mcnl(952-24n-4600) for ucili�y ti�ub as-built locxtions. <br /> UO NU'1'�aCAVATE 1N ANY STRCET AND DO NOT TAP ANY MA1N withqut cxprerv <br /> Hpprov�l ul�il�c Public W��rks Dep:►rtment. lssuance of a permit does not gr�uit�his approval. <br /> (7, All work musl bc Jnnc in accnrdancc with Sl,zu C'�dc raquiremcnts. <br /> �. t�ll wurk must bc inspected hefnr� ic is coven;d_ C:sill(�)52)249-4f.ipU,24+tiqur nqtie.e required. <br /> TYPE O� PERMIT � +y� ��urµ�! � <br /> __ 4 ,,,,_ (Chcck�111 That ApPly) <br /> Rcsidcntial(May Itcquire npp�uvr�l) ❑C:ummcrcial (Approv�l Rcquircd) <br /> ❑ New C:onnecu�n ��� Adclitional Conncction ❑ Re-C'onnection ❑ lte:pairs i�connoct <br /> ❑ Watcr Availahiliry C;onnec[ion Por 1'�ul.ur� I luok-Up lq W;il�r <br /> Job Site/Uwner lnformation: W����1 <br /> SiLc;�lddretis: O� `� ��� L� � P(� � CO <br /> � 1 �% � <br /> ()w�cr:--.�_�(`C•� ���L ��'�1� Mailinb nddress: I J ��J '"- <br /> � �Cit ���.:,: � �ip: C� c`7� .� __._, <br /> I fom c Yhonc: ��j �����SnZ(� /�Itcrnatc Phonc: <br /> I <br /> Co tractar [nfarmation: V <br /> ----...,,.,...,__.._ <br /> Ccn tractor: V .�T�(;'i-�i'Co�tact Pcrson: . (,)'l C., ��r-���. <br /> 1 �, l-� p <br /> Ad ress: ��� ' ' 2 '�tc Liccnsc tf: ������.�.._. <br /> , � _ . � , /� / <br /> C.'tt ��, i %i���Cxp�ration U��i�: L�/ � <br /> Pho ie: `�GJ��,,,�Z1�� A Iternate Phone: ���-" �ZJ ��C���� <br /> ! <br />