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P - 4132369i2212011 06:18 7634130456 STEVESPLUMBING PAGE 01103 .,,,N �., �, �,,.,v� �.��., ���� lOJ�I�-1�517.5 p.�i Enginccring WA�.'�'ER A.Nb SEWE� �czxxz�tNo.: ' ,' ' :� c�4 -'� � 763-5'72-3552 f FEIZJ'+'��T A��'x.,XCATiON ,° Received B 7G3�571- � 2'$7 f�t� C�TY O� �RIfDLEY !�:�� t�' K� �) � [�� ,�' 1 t EFfECTIVE Q1/D12D1 S �1� R�C''d: " , G TJ'PC.1CATiaN DATE: � L� � 1'bLJR �-M.�.1L/FAX� � THIS APPLICANT ;S: ❑ L�'N �CON7RACTqR � �tos ao���ss: S.��i�_. S�'`'� Sf rF_V�� COySTRIJCTION P�Rlvi1TM (IF APPLlCA$LE;: �� 0�� �� 'i�NAN'i SU'B.MIITA �OPY QF YOUR ST.dT�' t/C�IVS,E Wi7'tJ .� �,��rc,� riaN i I�.F' NAMF; - ADDR£SS; - _ CCfY---- _ ----- ,_$�ATE ZiP PNOVH� T3AME:��C.tt.tL.� %4er�p , Fti � ADDRES,S�:� 3 �tx I.JWS�-I CITY Lr�T �C Z- STATE �'N��P ��� S� PHCINE �(i� r �.T�_ s�'fj� CELLritipN�: sTArE ��c a ��� �� � �H.. STnTE80Nn _!_�� �iFS` EXP DA'I'�� I � -I � descriptian: r i i 2. Please ati�ckt sketch showing curb line, utility linc, buiftling, ece. with distances ox� ba�k page. 3. titiputatians:�'P� '� -`G ' 2. dl..�G � ���y.V OL �'j.:,�.�i.�� „� ,_ _. c. � � u.� � . . -_... � �. ���'` � � i -�` �-� �: �.4, , ..y..� 5 � � � � �.�.,,�—�-� � . �: �.... � � � �,,.� - .,�.a..` iYli�c".L � �lx-� �� �-- � �---7 l� �.L .n c: � T(j� w.47-EiL T/C�it T, b, C�i �'� �'�r'�zu � --%l 2�-►+z.� n,�r� i iL �. 5�- 3552 P�Rh'l 1T TYPE J72-�SSt.. 372-»5( `>s2- s��:1- I S"EV4`�!2 CONNECTFON PE�ZMIT�; iF.WF.R T�fSC"O�TdeCTPERMTT .i50 �G> � I WA1"ER CflNN�CTIaN PER1v1iT�i, WATERDtSCONTJGC'i�is}ZMIT $�A � �'� — � wATER LfT E REPAIF� �40 ' ' �E\X�ER Li2�E R&pAIR $4d I ADD $TATE SUItCHARG� $S.OD for eaeh permit /� ' i SAC CHAR�E Q $2230 = ' — - ra�rAL s /i� � C1T1-!FR C'H�,T�CE'S (IF APPLICA$(,.�} AAY T4 UTiLITY ���,,�„I1VC NEW WATER 1vI�TER C05T- SEE 1JI'1LITY S1LL�1G SP�CtAL ,�,SSESSMEN�S - SEE FINANCE W.1TER Ti\P - SEE �NCINEERTNC NOTE: WA'FER NfETER R�PA?l2 fNSP OR $HUT-OFP / EVENINGS, V.'E�KENf�S $t i30LfbAYS $125/EiOUR-81t TH1.S 15 AN R?P�ICATI(7N FOR A PFftivlET-NOT VA�ID UNT1L PltOCE$5EA I her��v apply for a�ater ot' s�w�r (new connection or repsir) permit and i acknowlcdg� tFiat the information above is co�nplete and accurate; that the work w' e m Gonfo nce with �ha ardihances and eodes of the City oi Fridlty. I onderstand this is not a permi� but nnly an ar�,Eicatic,n F�r a. rr. f��nd u•or c�s nat to sca,t wEthout a perrnit. SIG?��ATURE OF APPRDVED BY: ���� ��� ��: I. i N,4ME: �T� r�'' DATE: /'�Z!%�` DAT�: - �1 � i LITX �I�LING on! i�new meEer i,.i pUBLIC WDR}CS l- ENGiNEER1NG City pf �rz�ley �nt�ineering Depa�rt'tnent 6431 U�tiversity l�ver�uc NE, �z�d�ey, MN 55432 76�-572-355�. kAX; 763-57�-12$7 'Y7 � 4, v� �' �II � ��' �� ` � ' . F P;,� �` � � � ; i , � � r `t , � ,� � } t. �S � :c � . ;`� �4` I� � . . w � .�.:� �I �t.� r �' �� � _ . � .. � �� ; ��'� �� _ �� �. � .'� . s. y �- ,s i��. -�., 'r �$ t �, � c� � , , �c � ', ` � : k .� �' �i � �' -� �, � : � ��y,��'' +, � � , �,��-� �� ��;; t,' ,�, �ra ,� , <, . , ' r„ F � - ; y C.n-P.,�..�..:. . - . . .'", �,;.,�., � , - . -�a 9. .. ` '`,��. ' :� � 4�)�F!rc+ .�:' F `. '��'6 _ �_ , , , :r,� .. � � . '' Y � "i'' ' ' , �; ' i � s � �,5 � ' y�. _ .. .. . .r i . � �"'. . � i�t��,�' � . . �IG' p , . . iw� Re .'� ',1� . . ',R 1 ' . ' ��) . : :. � �,: . . ` , � -., � ... i . .. . � � . . a N�, . . . � ¢ . ' . . . . � " . 1�.'I (. � , � . . . . .0 � . oa.�rw..� . �� t� _.!��.1. �T� . . ! P �j � � ,fi r�x„' � � s -,�.� ; i t � i > � F�j,, . q a, � i �� i � . .. . - y \� 1 el, ��r �, '.:u � � � � � � - QJ �� � - � �� . "..rp `�'a r•ruy � � �4}� � k � �� � -1� `,� .;'. } ,. ��°',� � � �.� f ,��� .�. . � �� 1 � . .. gA, � . � . � �r� G.: . �i .a d� ��:� r � ' 1�` C. i a 3�" � t. � - , . .. � . � d� 5 .. ' � d. � .. � of,: . � . � &'� _ ' . . , � . . , ��� � . � _ t � w.� .z �.i.ti., .w.._. ! `'��i� . . '��' `- p •� � �� ���� . , � . n? a. , . `s.�: � },; � G�j �^��\ . � r:_ �; , �. � . .. „ �� . , ` A ;; __ . . �.,.. _ ..s � « �.. � , , { � . . �' :* - _..��erk� q �...:Ay °''i; � `� . - . F �� s� ���� : : ��, 3 . : � . �� � _ ��;.�. � � ., - � � � A . V 1 �. � A�� � v 'r� ��'< t =L— `�� � `• � ' ` N � ' � �' -��''�� � � ' �'�`� �"'�' " ,.�1�� -L `; 4� i � ,*_ . +�.�, ' _ `,' y, o . ' �j { .. � ` ' �j . � � .. V `i . F�` . �lni � : fi.� d �. $�� . . � _ i ' � i — ..-� S �� �` �' � � �� y .;� � t� , . . , - . . ,�� f r � - ^ � Y.`� " V' 1 d E s � � � � � . a �� '� ., � � �... � ... � ,�,�'� � �-,, �� '�t„ :�^? ', � � � ' i�' ! � �' ++.� � � '.r � r , � � �Y � �� TZ � i, a S �_,.' �` �� <� � � � �� �� ,"'". �. I ' �'; � � � e i �1 � , � � a �: �� ! �f � , . � f .'�>... � � s� .� i� ' �� . � .- . . 1 ��; ...J� . . . . i � ,^i_ � � }}-.,,� u..� �,� .j. � .f , . ��.r '* � �,. h �;,, � �a$[ � y�- a k i -�i� �' � . . � �� i � . , � . � � . }P < 5�y ,�. 'y, , ��',�µ��y�, .,, p .. ' . 1di