Permits - Permit# 11-6-17 - 2494 Black Lake Road - 1/1/2017CITY OF SPRING PARK APPLICATION FOR: STREET OPENING
4349 WARREN AVENUE & EXCAVATION, CURB CUTS, APRONS,
SPRING PARK, MN 55384 INSTALLATION OF UTILITIES OR
UNDERGROUND CONSTRUCTION
(952) 471-9051 FAX (952) 471-9160
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SITE LOCATION SUBJECT SITE ADDRESS
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SITE OWNER SITE OWNER'S NAME
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CONTRACTOR NAME KCCG
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TYPE OF SURFACE TO BE DISTURBED: --PERMANENT
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DEPTH FROM SURFACE
DIMENSION OF EXCAVATION
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WILL DETOUR BE REQUIRED? YES IF YES, DESCRIBE ROUTE
I hereby acknowledge that this information Is correct and that I agree to conform to City of Spring Park ordinances and State
law regarding this construction, and further agree to pay the permit fee and if at any time the City of Spring Park shall make
any improvements In any part of the right-of-way which affects the utility, then the owner of the utility agrees to alter, change,
move, vacate or remove said utility to conform with such City improvements at the sole cost of the utllity company.
APPROVED BY CITY OF SPRING PARK: APPLICANT:
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