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06/18/2014 14:19 952-955-5071 BURNS EXCAVATING PAGE 03 <br /> �-��ar�.Y � 9 <br /> ��0.�� CitV O�OronO DntC l�ecea'Ve� ,'�ntc k �r; ��. . � <br /> f � P.O.I3ax 6G � i "'" /� <br /> 2750 f;clley Pnrkway �r�tWl'�'bi1��'SA�D tlrn'f ut;oe Fnrm CCmpl�tcd //U <br /> �\s� , � Crystnl B�y.1vRv 55323 ' ' /D�r l/ <br /> ^ :;/ (9g2)249-4600/Fax(952)249-461 F ���r�W��'Iny(�t'�T�eq�urcd), ` <br /> ��'�l�x�i�.r i�i ot6�,, <br /> ....._..._... <br /> CYTY�F dRONO� SEVVER&WAT�,k/GENERAL PERMiT <br /> (+�tiate;Somc perm�f�muy rtqulre:�f7provnl by Che Building Of'f?cisl lnd/ar Puh!ic Works De�¢rtmcnt'") <br /> ('i',^^":"""" Me�bc suUlect to Ei�rthcr revi an�i mnv not bc ieaucd wBcn tlae apnlf.S0.lion 19 reccivcsi) <br /> ��'��� ��! !����. ,,�� <br /> 1. You m�y t�pr�y fot utility permit's by mail ot''tn nerson aC the City oECces. <br /> 2. M.�31ed in applications A.t'e Subject to the postag�attd handting fee shown belpw. Per.mit cards wifl <br /> be sent by return mflii within 2 business days. <br /> 3. Per►�uftg are not valid unt�l y0u receive a permit c�rd. <br /> 4. Work must not begin unlcss the permiY Card is available on thc.job site. <br /> 5. i,ltility Connection�czmits may bc�ssued to licensed contr�actors only, <br /> 6. Contact the Public Works Depa��tment(952-249-4600)for utility 5tub as-built locat.ions. <br /> DO NOT EXCAVATE IN ANY STR��'�T AiVA�O i�iOT T[1P ANY 1V�ATN wit�tout express <br /> approvA�of the P�ablic Works AepartmenC. Issuancc of a perrttit does not grarat this approval. <br /> 7, All work must bc done in accordance wich State Code requirements. <br /> S. AlI work must be inspectcd before it is covered. C�.�1(952)249-4600,24+�pur notice required. <br /> , ���'O�,��i �I�1VI'I�' <br /> �C�ec.��li Tha��t.4 Z <br /> �IZesidcntial(May Require Approval) ❑Commercial{Approval Rcquired) <br /> [�1�Iew Cont7.ection ❑Additional Connection �Re-Connection ❑Rcplirs ❑Disconnect <br /> [] Water AvailaUility Connection.Cor Future I-(ook-Up to�atcr <br /> Job-'Site/Owneir X�Y�ormatiotx: <br /> Site Address: �L/ L ` �� <br /> . _ � � Z_ � <br /> owner: ...��LL a S(°� � MaiJing flddress: <br /> c;ri: l��U��-r� � za�: ����y 7.�_. <br /> ,,� <br /> Home Phone: Altcrnate Ph.one: <br /> Gon�`actor I��a'irrnati'ib�; <br /> Con.tractor: �,Q ue.r Contact�erso��: v���t'� �l.C��. <br /> �1 <br /> Acl.dress: � 71� �b State Liccnse#: � ��- <br /> ��ty; c �ip: 5�3�.(,)Expiration Date� <br /> Phone: �� Z �I S� ` lllternate Pl�one, L �f� ���-�� �� <br />