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�_�._� ��� _ � ._ <br /> � TEL No . 612 427 9448 Mar 27 �91 13 �35 P .01 <br /> V��� L.�i .�� � <br /> C�TY Q� 1���aSo BrOWn Rd 1 APpLZCA�IOP� ���Y P81�l+1x�S <br /> y <br /> Sox b6 ( s <br /> prystal Ra�. MN �5323 ' <br /> 11111F1r!#1MR�*�***�#Ir��*!F*��/rR'klr���*�'*+k*tk*�1k�11A'�+M�kie�k*kR**�ir�k«+k*Nk1YM'�#*�*M/r�krlr+kit i <br /> �eraY inrtxacii�b� ntiXity n4rmit� by fiai.k or in ger�an �a� tha cs�y o�lic�m. <br /> 7.. You �sy �PI Y <br /> �• M�i X etl �n app X ic� b�+ scr+t ba retiurn +m�� ha a1�tn� d y tha ■pplioat d!S� xace�v d�ow. <br /> Farrni.t c�xaa r�i i Y Y �� ��� <br /> 3. P�x�td sre na� va�id an�:i� �an xa��s a i� <br /> 4. work must not bbqin unissr the pes�nti� card ie 11vA�1db�.8 on th� fnb •�te- <br /> b. dtil��y aor�necti�ar psxmSti� m+ay Ae� ig�usd tic Xia�l���d ��If��'!ldtOrs on��►. <br /> 6. Contnct the PabXic wdrke D�par�ment t�7��'7�57� �bx utility etvb ae�buit� �.oce��iona. <br /> AQ NOT ExCAVA�E iN ANY S�REBT AND DO�N�4� �rms��doesln� qr t t�it �►pprovuX,�el of tihe � <br /> p�}�Yi� Work� Depaz��met�t. zasuAnes o P } <br /> 7• A1�. wor.k must be in peatip4abeforeei��iehaov�rsQ�adC�X$47'8�7357�• <br /> $. <br /> Z� ��� noti�� ��1tl.�ed• <br /> �r**�+t�e�k*1��**�r**Vt�h*�r*,k**!�*��rw***�rr*ik�tve*��+krr*A�Yre*s�rr*w�t���**,��*ww��r�w****A�,��k <br /> �a$ SIZ'E ADDRESS! fo �v �c.�c� �..;��r� h s+�r� �� <br /> OGoupancy �'YPe= „�,..,. es c9a+—n al �._ omm�ra�ai�— <br /> OWN�R'8 NAi�: � / . Fhone No. : - - - <br /> Mai.ling Rddre s: ���Y= <br /> G'dNTRACTaR'� �AML a sus. Pho31�4 <br /> MaiJ.ing Addresss Citiy: < Z pr �S�d <br /> ***+r�►�r,r* �w��rr�r�i <br /> *******�****�*��** * � * *w* �PBRMI�' TYPg ANU 1�8� GAr+CU�ATItnI <br /> i�NICI�Ax� SEWER �QNNUCTI0�1 t �3 U.04 p��r $tub) $ �ixo"n'— <br /> pipe s�z� inah�s = matexial �,,,�,PVC ton s���rmiit a��icatia�ns unless � <br /> SAC Chai�e (�5+75.00 ) mus� �aaompany �]� � �e��r F' �� s <br /> p��pafd. If not pz��a��� A s�wer coririectian ps�m�.� w�.X� �a� be i.�eu�d. k <br /> MQNICxPAL WAT$R CONNBCTIUN (��0 .u U p�r ��u�1 � _J� •� __....._ + <br /> p�.pe siz� _,�,,,,inche�t mater�.a�l „�„� cappex't o�her � <br /> WATER METERs mus� be pic�k�d up e►nd paid �or at Citiy a�. . <br /> (5�8�� metea�s = 5111� 30 � 3�4" m�ter� = 51�6.28) i <br /> i�s�er m�tera must b� ��t aad �ea�ed by arano Wat��r Dc�partment I473-7359) � <br /> upoa o�mpYet�att o� mete�' inetall���on. <br /> � <br /> REQL1zRED minimum se�t��� <br /> ks ��'Om ftxainfl�eld and septio tank� � 7!�' <br /> A�Q[IIRED setback �rd�ct ��wer li,ril� � 2� ' <br /> ��r*w*+�***�►�*rr����*w��***�***l���+k,k�**,r***�*1��*rr**��r���R*****rr�*�1A1tlrle*+k*��,4*�!� � <br /> � . Subtot�tx og abov� p�rm�t reque��t�d S .�------- � <br /> 2. 8tet1� �urcharge .�0 � <br /> Th� E'kate Bu�.idi.ng God� Di�'� n� w�CCr aonneot�on Fe mi� r�qu gted. � <br /> ineludnd for �a0h we11, �Awe � <br /> W 1 i c a t�.t�ri�1 � 1.5 0 ,�,�,,,.,,,,.. � <br /> 3 . pr��ta�e & 8undiing (On7.y maf 1 iri app <br /> 4 • �OTAL 1'E�tM�T FE$ (+�dd llries X�3 above� $ � � ` �� ' <br /> ��� <br /> +kdr*�t�l�*k**�'�**�*R*�Ir�kdk�ltt�tkltA�'�1rtk��lr'ktklt**Ik1kV�**tk�lkditlk#l�tlttktlr tktk � <br /> Tha undersigne9 hereby applies �.o the CiCy nf dxone� !�r i0�uana� c�t a tit��itiy p�rm�t, <br /> eglrees to da aYi work i�n ��x���$ao�grd�nd certifiea th�tiaiic$te►teme�t�C ad0 0� �hie <br /> sMquXatiors a� th+� stet� at Min , <br /> app�.ic�tfon are Comp�.et�, truM sria oorr <br /> aa.�.,m�,,,.e �,g Ar�oiicat�ti t - _ DI►��t t 2 � � <br />