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Feb 03 18 04:34p A.L.Sheremer Const Inc 7632677299 p.1 <br /> M <br /> 1�"'� Cll�Of O7'[i00 ��C�Y'U�ONLI' <br /> "- � PCru�tt/1 � '-��_ <br /> neieRzcei�ed: j - `,C I� -f <br /> � P.Q.Bmc 66 �— <br /> ' ��S 2750 Kclley Parkway " <br /> Crystal Bsy,]v�l 53323 �ln-Hoasc SAC Dctcrmiuslion Fmm Cuomoleted <br /> =z'��tcsHo¢``` (952)249-4b00/Pax(952)249-4616 ��' �� + �% ;�,-/-�l� —/f ]7� � <br /> �°�Ppnn'ed HY f�t'R�4uirrd):. <br /> CTTY OF OROI�IQ—SEWER&WA?'ER!GENERAI, � �� `� `\� <br /> PERI�TI'I' � <br /> ,t��. <br /> (*Note:Some petmits may�ire apprpval by the Build'mg Official end/or Publie Works DcpffitIDent•) ' ' �� <br /> (AX.L PER.__• - Mav be aubfed tu ftMher revirw�nd m�v n� e ic�oed wLen the anol�catin ° <br /> p u recernedl. <br /> C'3�J�A�.INF�RMATI�I� � ' - . <br /> 1. You may applj,for u�ity p����,����on at ti�e City o�ces. . . <br /> 2. Mailed in applications are subject to the pastage�d bandling fee shown below. Pernut cards wil� <br /> be sent by retum mail within 2 business days. <br /> 3. Permits are not valid nnt�yoo receive a permit eard, <br /> 4. Work must not begi�t uniess the permit card is available on the job site. <br /> 5. Utility connecii.on pernnits may be isswed to licensod contra�tors only. <br /> 6. Co�act the Public Works Department(952-249-�600)for utility spib as built locations. <br /> DO NaT EXCAVATE IIV ANy STREET AND Dp NpT TAP ANY NIAIN wi�oQt�p�s <br /> s►pproval of the Poblic Works Departmeat. Lssuanc�e�f a peimif does not gaaf�his appray�, <br /> 7. All work must be done in accordance vvith S'tate Code rcquiremeWs. <br /> 8• All wark must be inspecced before it is covered. Call(952)249-4600,24+haar notice required. <br /> TYf'�Q�PER�i�"I` . , <br /> Check All'I�t;� 1. . <br /> �Residential(MaY RecNu,e APPz'ovaI) ❑Commezcia,l(Approval R,eyuired) <br /> ❑New Connection (]q�dxtiona�eonuectiom []Re-Connection ❑Repa.irs �bDisconnect <br /> ❑ Water Availahility Connection Fvr Fttture Hook-Up to Water�- <br /> Jab Site l Ov�er Lu£ar�ataon: <br /> Site Address: I�7�n�.�-Fo n� �-i�I��4 v��5 Lc�v►� <br /> ���� Mai.�i.ug Address: <br /> City: Zip: <br /> Home Phone: A]ternate Phone: <br /> co���r�a����: � 1 <br /> �.�-., s�e►-l"�er� �or�y�•i�� <br /> Contractor: Contact Pezson: �n t�y S�+er+��r' <br /> Address: ����v►�► Gv N state License#�: �(�,��-�1 �C, <br /> C��': c� n �p:� Expiration Date: j���- I "r <br /> ���1 � <br /> Phone: �,�� � -{��I Alternate Pbone: <br />