' �Y+F�4�Y �'ERMI'T5
<br /> L.��.��` i.d'i L:` .'v'. .�aI i4 h 4t
<br /> Bo� b6 i 1��5 ��,� �rowr, �� �
<br /> Cz-ysta3• Fay. MN �532�
<br /> �wK*�rRwk�h***Jt**Ak***�k�t*hir*1�***wtM � �#� ers���*tc* a ,aaa� ��ks�tr�t�rw�*ir*rr�.��v�ir�Mir,�R�t
<br /> S'rexsere"Y Is�st:�eti�o� utility r-�rmit� AY ir�3.t 1 ;�r iC1 �ers�n et eT�e Cxey off�.csg.
<br /> �.. YOu mey P� �' � t, thP UYtt�9p t+t�d hn11dl9ng f��� showtt tial�w,
<br /> i. Met1 X a8 �n a��1 icit ian� e��'� sub�eGt � �'
<br /> Permit caf:a� MrilY b� scn: i�y Yeturr me►il the e�mo clsY r�e applic�tinr Sg xeceived.
<br /> 3. pfr��te ar+� nnt vaii� �3t�i�. yot� X'��ive a j►�ez�tc csnrd. .
<br /> 4. tr'ork n.:iRt nat bPrqi-� �?nleeo the �,ermit c�rd ia tt�re►ilable� c�n r.;,e i�� �ite.
<br /> 5. util�ty cannect�ar. yer�ri�6 m�+v bm lt u 4;�Q,�S�1� fOr. utility� Bt�� nag""t�Lil� �cce��or,s.
<br /> 6, Cor:tn^_t tt<e Pub) i^ we�yQ "��p8� . e ( ��$� apprp��,�a2 �f th�
<br /> Da xo� ExCAVAT� �h ahY ����ET ��� �'c� h�T ;�.r nr�� MAiN +�ichou� ��ie a rav�z,
<br /> Publi; Wor�s Ge�artment, Tssaan^e Of $ p�rnit doee nb� gr s�t�
<br /> 7. Ai] work muet be inspeit�Qnbe��oreFiC���r^overbQ��dCe�l�g47�J•7357$'
<br /> $. All
<br /> Z4 hoqt �nt�C�+ 7�M'�1i3.tCd= ;
<br /> tr*,t,4�K�,lA***�t!*R*Y��r#��*kerrrw �lr�***VtPrxir�r*1r�R11��R�ttr**tr#M��I**x�A **,�wfw.r�r*** �r*�.�t -
<br /> � �'��1 T+ ��_,a_t--- '
<br /> l�; ;,,.� '�(�,+�`=: t� ' �t /rt _���..-- ---�---�"_'.�.--�—
<br /> �70A S I TE ADU�S S t � �_,,�, .---,--•--# „
<br /> 'Res���arn�1 " +.Oi[�mer�ia�
<br /> Occupancy Type: _�.�,. -------- �
<br /> �
<br /> � ,�, i ' ;'�;�.�,_� Phene No. i - - - --
<br /> AA�, a �. , ,�.,�:�,�,`:'� r—�- h ---�---._._.._-- -
<br /> UWLVER' S N . ,_ • _.._ .
<br /> c',_ ,.y s � _ __,_ __-�
<br /> Msi.ling A�c�xess s t �-..�-- ""'�
<br /> �.w- �
<br /> NAME ` ,, t . ,� � '� f-,� [ =Y-�„�!
<br /> Ht16 . �hbi1�: '�" � -� • ' "r
<br /> Cbb1'�R.�C t'C.�R � $ ���-r,��"wo.'� � �_�.C''��.� C i Y . 'f� �'_ Z i.�� r �.$��� !
<br /> MaiJ s i.g �.�drw�s: ��- �� � ,��_���-- Y � ���� �
<br /> rk*�*#�*R *t#*�****,t� wrr i �r**�xk�iti�*�*tesrtic`�i'�;r�k�t�%#ie�i,r�#* ** �N�t#st�� t
<br /> PBRM�'t` fiY�� ANU Ft�& ���Tx{3� ,
<br /> MITNICIP1d,Y. SLWER GC7NNr�T1U1N : '� ,,��; , �.{; ��: �t:�b ! $—;�-,,--�-_ �aSt ix�n !
<br /> in�;h�s ; �t�a�ea�a� Y1"� � c-,n s�►r:� fi�� , i _ L
<br /> pipe sizes _; �. �, c ^r . � u:;" � �. ' ��w�r ��rmi* d�p� f cat,�o�6 �� . es�
<br /> S Fr C (�f:d z�� � $a 7 �. � �` rr�u� t. E�: r r . + 4+�,�. �,� ��S�tl H�•
<br /> �re�»id. I f nct pz���:�a ir1 , a �c:����r :�^nn�_ t ��n pe�m�
<br /> ?j0 -c9-a
<br /> WATER I.VPIl�L7�L�1JS� � Yfi� �•.' �lE`t� �f '��'i� :�' �.�__.--�._
<br /> t � _�.mm��-
<br /> MQNICTPAI� . � er , eth�r _
<br /> ���,�P s:Ze �i�;t�h�8 r T�*�r�t�: ,. ����' r � _----- --�-
<br /> WP.Tk?+ '`g �'£R� ^'t�:�t : � � � -►���a t�F:; �ri�' � � :a f f0� F�t i .�y'��,.�.� .
<br /> , � ,..�. ��5 . 28 >
<br /> ( �tFi" t�et��"s = $]_.'�i . .��� ; ?.>4" tT�et;�r� � �
<br /> W�ter �r►e�er� �nust b� �t�� and ��a��� i,y t�x�na Wat.e� Dep$r.��snt �473 �3�� )
<br /> upon corap�etian of �etez insta� l�a��:an�
<br /> � � `r�rc� ?��`s� r:f�el� �r�' ��iptiC �ank&� _ ?`+ � '
<br /> REQIIIR�;i� r^,1rilmum �etn��:�.
<br /> line � Zc� �
<br /> R��r.:xLr.� se�nd�-�= a a��, s�a��r� # �x��*�*x��*«�*��***��
<br /> ��t*w,� k*x �*r� � K�*x*x* ►t�� a ,� �c .� ti� �lkfi41k1t�*a �,c*rea,�fi��**,►*,rw�. � _...�
<br /> 1 . S�zbt�ta� ^� �boi�a t.�r^ � •_ ��:��,��:��tf_:=� .�--.�---.�, ---- - ,
<br /> 2 . St�te Surcha�9e+ ,�. �,� �- , ;> z p�:m..t "^,uS�t�� '
<br /> n� ' !"� -� ,` i .�]L".J�i i�:`:� _:!��1-�� ' � Y"�� '
<br /> �r t i� �Cr�.���' ..��li 1 1 :� - .;4 _ k � - � y. '!t� *�,3(� '
<br /> Y:r� �. i. ;��r+'�: t?T'�� °����� `vw�il:�3�:J.C;': ri¢�?''t.t,4 X��� BBi- +
<br /> j ncl u��cl for �?�Ct� _ �
<br /> 3 . g�st�ge a Seiidl_ing `. �P;"i..: ;�� 1 -S;'� zt,.;��ica*z;�rx� " ' _� : `' � �
<br /> . ; ,:� , 30 - � '
<br /> 4 'I`c73`lSiL �=L'!ttl�i.�'T° ���? r� a•; .. '�: , . � ;_ . -_ . P _ , , . - - 2 - _ x
<br /> � f t.ir* w*�t#� ^ _ .
<br /> �kw*tkR �c �kir� tt,� *fvr �r. x *� f �: ,rx*�krw � o� . x . � ,► � �kt� �
<br /> ':'t'4 i:7;<jP' �' r����3 �+ET� ... � :T;i . �� - s� ` ; t� , ',�2 , ";.''t�r�,,:+'+3 aF �'^i2 �Cd �`� LI�`.Qm _
<br /> � Lt ,
<br /> , F .;�, rs_ _ �r���
<br /> ` 'P i ' ' ' � , '�, � < �,� - . _ c 'r`.-• "� - ` _�- , . '� t ti.. 4 i
<br /> 8gf$t-€ ! C �:` a a w"r" LL t ^ *�` a i
<br /> �� f i + 1~i t�� �r��P fi 1 i 1 L�:`•���P. '*'.�' � �1�,
<br /> :�: ult•�ih " 1tT: , _�2 �
<br /> rp�u� ationa o: t��k Stt+t.e �° ; �
<br /> bppl icnt.fon oro oo^'pi =�t�, i rue� �,,�� �'w rrc ,, . I
<br /> �n '� �
<br /> �' /? >
<br /> �.�
<br /> _ ."��t!� _ " .�; �-- —,_ --a s
<br /> f . ....: . s . �..._._
<br /> �
<br /> 3�v� �- 3�.n�
<br />
|