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. � <br /> ;?i'j C3}'^ CJ a<���i _ - - . _ : ...' ,. . . ; . <br /> � `�% .,,_ �_�i: �•:� - ��. _� .'1_:. . <br /> .��:. , . ..._ �j <br /> tn�taf 32�, ��I:;�� ���:,� <br /> %�''�'F:R.�T.I1�CrRh�A7'zQ'�_ . <br /> '., k Oti i;lfi�'a�.+})j iGi U:t1:T;'�.wI'1^.7:5 h)'iri�il �:::� *1Je754.^• at°�...C;��O�f��5. <br /> ?. :�ia��d i:; appiicn:iens w�c suL�;c:t .:��?:e p�sx;e�.�d har:�:in�ice�':o�;•r.be{o�,�. ?':,�-�^it c�r3s L,�U b� sen:by:c�:sn r•i�i;'r,c srrr.c d�� <br /> th�applic:aLior. is;eccived. <br /> 3. PeFmits are reoi vaIid unEil yr•u rc•ceif•e a ��rmit card. <br /> V:nrk tr:Gst r.ot begin unle:s the perr.;it.car�3 is a�raiEsbic cr.�hc.job si�e. <br /> � �tiliry con:•zeciiar,pa:miu raay�e is:ued to li4enstd concac.:ors only. <br /> o. Contace tne Pub'.ic Wor4;s Dcpant:ienc(9�3-:49-4604)for�tilirysn:b as-built loeations. DO'r07 EaCAVATE i':�Ati�'STREET A:�� <br /> D�?�OT T.-,P ANY'.�lAP.d u'ithout express approval ofth:�'ublic Works Dcpar�isen:. Issuance uf a permie does not�an:this approv,l. <br /> 7. At!work m�sc 5e d�ne in�ccordance�vitl�Statt Code;eeui:ements. <br /> 3, Atl work tr,ust be inspectad befo:e it is co�•r.cd. Call(9:2)249-4b00. <br /> 24 hour��otice required- <br /> Ja� si�rE.�np�ss: 3� L'� ��n�_� O�o�,v , -- <br /> vccu�ancy Ty�e: Residential CQmmercial <br /> C}�ger's hiamL: �ve��� �n�o�S2 Phone?�'nmber: 7Co�JS J`o�1o�t.P <br /> ti'�aiiing Address•��i �-113 3 C1t�:�lf�'►hh2c�O�li� Zip: 554y 1_�U333 <br /> Coatract�r's PtTsnne: �ed �XC.�..v���r� . Phone N�mber 4sa-�9�I -g3U(� <br /> �laiiiag�ddress:�40I W 1 �lr��' 5���.� City: � M�'Li�:5s3�.� <br /> PF,R:ViIT TY'PE � � <br /> �:.: __ Vluaici�al Se�ver Connec.t�on (535.00 per stub) _ _ _ <br /> .�.�.-�.�..__� _ _ -_ - - -- - - _ <br /> ._ �. r � ; _ <br /> � ,, _ -.--�._ ._ . _ ;, �^.:.-..�,,... - � =�.��.:.:�..:�n..:. <br /> - .,�.�_ __., _ <br /> -_--- �� �-_ �.;,__ - __ _- - -- - - - - <br /> .�.:_ -._ ___ � _ _ <br /> �;.- <br />_. .,��_ . . --. _-:. �-�Y. : �� _ �_� �:.� _. _ _ _ <br /> _ .- ,_ k- ,.._-.> <br /> ._ -._ �_ ___ <br /> ti.Vr.necUon pzrrnit u.l� 11Dt�e 1S�1'.F�. _ <br /> -�:-- �, __ : ' . � _ <br /> _r_ _ �� _ - <br /> _-._ - �O�Tt3�4A� _--- -_- _ -- - -_ _- _ -- <br /> �. ;;� � _.. <br /> - �= f�__. �-�..,. _-,�� •._ _. <br /> :_ . - - <br /> _. ---- <br /> - <br /> --�. <br /> ----�..�. : -�; =�- . _. <br /> - _ . `r -- - __ .. _ �-. . �.ar`.q. � 3 _ -- � — a�`-��Y`a� <br /> --�`atgr�use�r�ii.����-se�ai��"sc��'e��. r�i�ii- ;,�ce�",. _ �S�t�`��`���� � -��.._ <br /> instal�^nan. <br /> REQUIRED niir�im�..t�: setbac:•:s :z�3m draill.ield ,ia� septic t;u�.res = 7S' <br /> -::--- .._...._ -- �EQUT:R�D setbsck from seu-er Iine-20' <br /> -:. _- -_ _ _,. _ - - -- - <br /> �-_ ..�.,� �-- --- _ _ _ , _- -- _ - -- - — <br /> :- �_�:- Y.-�. — ...,., .�� <br /> T �_ , , <br /> _� _ ._-_--. _ _ - - - <br /> _ _ . _ _ ... <br /> —_Y---- —.._._.._�_ __ ;.� .. ___. -,.� �__-__ ---� ...Q-_:v;�,_ <br /> - " _,:�.�.i�...�---�:=s.,a•��.>=.tr.,�r:.�-- �' -'�"-�':�4. _ - --��" <br /> ' .. <br /> � Su�tatai of abov�peimit.recuestad - _ �: �~�. . <br /> -- -� .,, -Sta:e�z:rc��.r� - - =_ -- -_ - - - _ <br /> . <br />�_ . ._ _, ._ . e_ _ _. . � - - :- _ - --- <br /> _ -_ --.. - - -'- --_ <br /> _ ___ . ,. <br /> T*,e St2te Suildiag C�de Di<<ision St;rcharge of�.SJ ner rcr,:3i mu5t be <br /> incluccd for ezcn wzll,sc��er ar:d�va:�r ce:�necticn r�rr::t requestcd. <br /> ;. Posts e c�:�-Izndlin�(On1y m,ail-ir�applicaxions) � 1�'� ._ <br /> :+. T't7TAL PER.�ITT F'E� (add l:.nes 1-3 above; S 1 .DZ5 _ <br /> 1'he u:�dersi�:ed her���% �pp;i.es to t��e City of O:cr.o ior issuunce c�f a Utilit}� Fe.rniiz, 4grees to do al? work in stric <br /> ;..cr.r-���:"e ,�-i:li the ordir�ar.ces �f ihe Ciry•�.*�d�'�e r��-�'3tieas of tl�e St�.e cf��ir.;Ys�ta,and cert;�es Lh;�t a:l�tatcme�t--- <br /> n��u� o�t?iis app�ic�I1�J_1 S7e CC�^11�I�t�, tn:e�:.nd ce-�e�_ -- <br /> - _ � ��� �- _: _ _. - - <br /> J�ITS.r'.�i1..'�r�: U1 :'1�J�� �WTI�: ____- -- D..,� _�a y� _o � <br /> � -� _�. �� .�__�_:�__� =��-. .� - - _ - _ - <br /> � . <br />� � _ _ �._� <br />