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Jan 07 ib 01 : 56p p, l <br /> i <br /> FnR CI'fY U:iF�ON��Y <br /> ��0�� CityofUrunu DuucRu:civccl: Puimit�l <br /> 1'.v.liox DO <br /> z75n 1C�Ile,y i�.rkw�,y ❑In.Tfu�isc SAC Det�minaliun I'�urm Cpmpl�t�� <br /> � Gryeinl Doy,MI�I 57J2� <br /> �n ' ' c (yi2j2aq.��u� AooruveU 13y(�fre���uirca): <br /> i <br /> '�r.nwo�� <br /> CYTY O�'ORONO—SF..WF.R&W�1►TER/CLNEI�+iI,P�i.RMI.T <br /> ("N��te:Snmc pennits may r�equire nDD��a�bY��l�uil�mF Ulticinl unU(UI I'ub1�C Worlw Depar(rnenl') <br /> (,A�1 1 R�'�Ma'['y M r�rc n.Fiarl 1u f rll��r evtil� A rnrv wi 1 An I�a�t�when thq�y�l�"g8��yee i�e rec�ivod) <br /> ..,..._....�_.._.._.....�,....._.............__:_�. <br /> G�,NERAL IN�URMATION <br /> 1. You may aa�ply for utili4y pe�mit�hy rnail o�in ner.c�n at the C.ity offccs. <br /> 2- Mailed in application�are subjcct lo ihe poSta�e and handling fee cbow»below. PCrmi[cflr(1S will <br /> be scnt by rcturn mflil wi(hin z buSineSs d:rys_ <br /> 3. 1'cYmitx Hre np[vatid until you receive s perm9t rara. <br /> 4. Work rnusl nol bvgi�t uolcss Thc rcrmit curd is availnblc an nc�job sitc. <br /> 5, Utility ca�nactipn permits msy bc is9ued to licensod con��tors only, <br /> !,. Cont�ct tho l�uhlic W�rks Dcpartnicnt(952-249-dG00}for utilily bfub as-buili locatipna. <br /> DU NOT�XCAVATT IN ANY STREET ANiD AO NOT 7'nP ANY I�Ailv without exp►'ess <br /> approvs�l niuu Pu�lic WorKs l7epamnent_ lssuance ofa permit docs not�[fhis approval. <br /> 7. All work must bc donc in uccordFuace with Stacc Code requ�remenkc. <br /> 8. All work must bc inspcctcd bc8orc it ia oovcrcd. Call(952)249-4G00,Z4+hour nolUcc roquired. <br /> f �rvPr or PrRMi•r <br /> I �cti��k nii rt,s�n�piv� <br /> �lzesidential(May Ttequire/�pprp�al) ❑Commerciul(Appraval Rcquircd) <br /> • �-�1ew C:o�tn�Ccion �.A,ucNtionnl C:Oru+�don Q T{e-Connectipn ❑ I�epai� ❑DisconnocL <br /> Job Site/Owner l.nformation: <br /> .c. i�, �� � � <br /> Sitc Rddress� �—?����' � {t �f,�/1�'li� ��''�1,1-f���C..G <br /> C-. , � : , , . � <br /> �' ���Y-- <br /> Ch�vner� _��►�1;iY���'�)'(�{� '�.�/Y�-C� Mailin�;Addre�s: ��-'�7�i ._ '� ��l�f /� <br /> � �+ �� ` � <br /> Ciry: _T�.l�'1 C���I'� Zip: �- y�-��,�— <br /> Home Phone: 1r.�f,� --��'� ,��Z� - Alternate Phone: _ <br /> Contractor lnformztion: <br /> _J .'�_,f_1�1 � �Yl�T�l+`N n�ontAct Persotn. F <br /> COIl��l01': �J i' '(� ;�f��t,I <br /> r � �� <br /> Address_ c'--,�1�-�c���l-� .`._� I��'�-��'�'i��.L}+�-'C � <br /> Staie License#: � f ��'/��- <br /> �, - — <br /> J Il , .��,��� �- <br /> Ciry: (..�C�1' Q: > �� _ Zip: Expirativn Da.tc: � �' -�i����/� • <br /> , / l <br /> Phonc: � ���;3� � !.;� Altcrnalc.Phonc: ��r� ,-j.:�� l���7�� <br /> �=�/C�( <br />