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Lakeside Ave ROW Permit
_ � �,�(���� Au� 1 5 zoos E PERMIT TO WORK WITHIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS AND APPLICATION FOR INSTALLATION OF UTILITIES 1. Location LAK�SII�E f,U'L� 2. Nature of Work `�+�Ly 'g'F'`�D S,E iCV l e.E. CA$LL. 3. Tndicate below items to be afFecred and include a sketch ar plan of work to be done. Curb & Gutter Street Surface TraillSidewalk Trees: Pond/Wetlands (Publically owned Traffic Control Devices/Signs or Privately owned _) Drainage Utilities StructureBuildings pther $L!/D . ^ 4. Method of Installation or Construction CA�SLf �LOC.�I �- , SD�fi:: - ,�� �^ • hi 5. Work to start on or after: 8 " Z$'� and shall be compteted by: �� A y unless an extension granted to: by: j DATE STAFF/DATE ' 6. Will detouring of traffic be necessary? 1`10 If necessary to detour traffic, describe suggested route: 7. Provide with this application a copy of the contractors Public Liability Insurance. DETOURS: The Director of PubJrc V�p�s,s�sha�l,�e �qtti�ed �;wr@ting at least 72 hours in advance of any detour being established, ct►anged or discontinued. NAME OF APPLICANT =N ����R ��-L�C�.� ���.. PHONE RSZ-`�'�'����'' PLEASE PR1NT FAX q 52 - 22.1e - 3 7 5 E3 ADDRESS '�`�a ����� St. S,E. PI�1QR. LAK�. MN 553'7Z- AZ.9�t STREET CITY STATE ZIP NAME OF PARTY OR ORGANIZATION PERFORMING WORK CONTACT PERSON: mN 8 ARLFIGE.. EMERGENCY (24 HR.) PHONE #: � � 2 9� g ' S 8 8� ADDRESS DAY PHONE Q52- 22(0 - 7fl1A4 STREET CITY STATE ZIP _ The rsig rewith accepts the terms and conditions of this permit by the City of Prior Lake as herein contain d agree lly comply therewith to the satisfaction of the City of Prior Lake. Signe . Title: �� Date: �' �S`D� 79 . ,, 08 . , , ., '2I��I�II JI�Ifl .L.LI� ��Id'I �IORId �0 1�.LI� �H.L O.L Q�.L2IOd�2I �Q .LSf1YV aS.L3'IdWO� SI X210M I�I�HM S.Lda 8E-I.L 'H.LIM a3I'IdWO� 9fl '1'It�HS ..Sh10ISIAO2Id'IVI��dS„'I'7d I�IO oPld �I) �1�10 �J�d 1�t0 PIMOHS S.LI�1�W�2I1f1a32I'1`drJ�'I'I'Id �idai 9o-�r- 8 :� � . �� S�I?lOM �I'IIIfld :IO '.Ld�Q�]tg Q�A02Iddt� . � :paig3s �Cqa.iay se suois�nad �e��ads ya�n� a�ueploo�� u� auop aq o� ��on� p�es `uo�l��ilddu anoq� a� ui paquasap se auop aq ol ��onn aqa �03 palue�� �Cqa�ay si uo�ss�twad :a�e� ao�ad 30 �i� p�es �tq uani� �C�np uoiaez�ioqane o� auens�nd pue `suo�a�s�ado y�ns �uuano� a�e� loild3o ,fai� aya,�o suo�le�n�aa ay� y��nn s��adsa� �le ui �C�d�uo� ol auawaa��a3o uo�lg�apisuo� ui QL � ���/ �p�LhJ 'QHalA02fd ��I�I�CISI�II 1�.LI'IIflVI'I T 1 h '�- n �o�y ��uua� � •oK �d�a�a2I —� $ ;aa3 A (•� �O'I `P uoq `yse�) �HdA.L �.LPIf10YVd �1U.RIf1�HS 'I`d1�1�It�I�II3 .L1W2I�d :IO I�IOI.Lt/Z1210H.Ll1`d J�'II10 �Sfl A.LI� 210d «�„ ZI�[IHX� . 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