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a�C..� � �al���� ���E�vEo <br /> �� <br /> ' OCT 0 � 2016 <br /> / �O�O Street Address: Mailing Address: Phone: 952-2�+ �F�O�O <br /> 2750 Kelley Parkway P.O. Box 66 Fax: 952-249-4616 <br /> Orono, MN 55356 Crystal Bay,MN 55323-0066 Website: www.ci.orono.mn <br /> i' <br /> -� �. ; �G�F�(J�tpg�j � <br /> yF`RkESHO��`` �� Right-of-Way Permit.Application �.,:�.��, ,.:" <br /> Purpose for Construction: New ❑ Replacement❑ Repair� Maintenance ❑ <br /> Facility Owner: Michael Tolliver(residence) Project#: <br /> Contractor: The Garden Gate Phone #: <br /> Contact Person: Dave Thurk Cell Phone: (952) 200-7058 <br /> Billing Address: 7860 Waconia Parkway Email: <br /> City: Waconia <br /> State: MN Zip: 55375 <br /> Permit Type: Excavation � Obstruction ❑ <br /> Construction Location: 1098 Loma Linda Avenue - driveway and front yard <br /> (Attach plan/sketch of proposed construction) <br /> Nearest Intersection: Loma Linda Avenue & North Arm Drive (1/4 mi.� <br /> Excavation Size: Width: 3' Length: 55� Depth: 3' <br /> Excavation Type: Trench Hole Plow <br /> � ❑ ❑ Pneumagopher❑ <br /> Driveways � Cabinet ❑ Pedestal ❑ Other❑ <br /> Specify Other: <br /> Obstruction Information: <br /> List the portion of the R-O-W being obstructed: 20' of Driveway, 35' of drain tile trench (behind curb) -See atta� <br /> Obstruction Size: Width: 3' wide trench Length: 20' Driveway Depth: 3' deep trench <br /> Hours of Obstruction: Start Date: TBD at AM to End Date: at PM <br /> Construction Schedule: <br /> Start Date: Mid October(TBD) Number of Days: 3 <br /> Weekend Dates: End Date: <br /> By signing this document,I(the applicant)hereby state that the above information is correct and may be subject <br /> to change. If a change in any of the above information occurs,I(the applicant)will inform the local municipality <br /> for proper approval. Please send the completed permit application to: P.O.Box 66,Crystal Bay,MN 55323. <br /> Applicant Signature: Spencer T liver %-i1 Date: 9/14/16 <br /> Municipality Signature: t �`�` Date: /D .3��' <br /> O�i�y'� <br /> ��s. �� e� �z�� T ce�,4� 12`� �-f D�F'� ?'� �� T y pN�. <br /> ov�- ���� �a�ao � <br /> � c���- �,4� �r�s ��� �'a� ���►� .�vs�,���o� <br />