CCP 04-08-2002 - Laserfiche WebLink

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CITY OF ARDEN HILLS 1245 West Highway 96 ~RDEN HILLS Arden Hills, Minnesota 55112 . -~ Phone: (651) 634-5120 . Fax: (651) 634-5137 Date: PLICATION FOR PERMIT FOR INSTALLATION OF ABOVE GROUND UTILITIES OR FOR UNDERGROUND UTILITY CONSTRUCTION . . ~ Permit No. Receipt No ! Please read the attached information! Applicant Information Applicant's Name: Applicant's Address: Applicant's Phone No.: Proiect Information Nature of Work: Type of surface to be Disturbed: (circle one) Location: (additional information attached when necessary) S.' d kind of pipe, c , or cable: Depth from surface: Method of installation or construction (including method of compaction and excavation): Work to start within how many days: Will detouring of traffic be necessary? If so, describe rerouting: Gravel, Bituminous, Concrete, Boulevard 'Work will be completed within how many days after start: . The date when work is completed must be reported to the Arden Hills Operations & Maintenance Director. By signing this application you attest you have read the information and the above information is a true and accurate representation of the project. Applicant Signature: Printed Name: Date: City Hall Authorization of Permit ulAayment of permit fee in the amount of $ and in consideration of the agreement to comply in all aspects with th.et or alley excavation ordinances and regulations applicable covering such operations, permission is hereby granted for the work to be done as described in the above application, said work to be done in accordance with special provisions required, as hereby stated on the reverse side of this permit. Approved By: Date: