ࡱ> EHF@ Fjbjbܡܡ 4elvvvv8.Jl $(LSUUUUUU, pE{vv{{{dv8S{vvvvS{{Vc|8e/L \ v{v{ Name of Applicant:  FORMTEXT      Date: FORMTEXT      Address:  FORMTEXT      Phone: FORMTEXT      Contractor s Name:  FORMTEXT      Address:  FORMTEXT      Phone: FORMTEXT      Street address and/or legal description of work location:  FORMTEXT       Type of Permit FORMCHECKBOX Water Connection$200.00 FORMCHECKBOX Sewer Connection$200.00 FORMCHECKBOX Street Excavation$100.00 FORMCHECKBOX Curb Cut Permit FORMDROPDOWN $10.00Commercial$10.00Temporary$10.00 FORMCHECKBOX Sidewalk Permit$10.00 Permit Approval Required Before CommencingAmount Paid FORMTEXT      Date Paid FORMTEXT       Inspection Approval Required Before Back FillingDate Inspected:  FORMTEXT      Inspector s Initials: FORMTEXT       I hereby acknowledge that I have read this application, that it is correct and agree to comply with all laws regulating such permits. Applicant or Agent CITY OF EARLHAM APPLICATION AND PERMIT Last updated:  DATE \@ "M/d/yy" 4/29/04 Page  PAGE 1 (*>@BLN\^rtv 468BDZ\prt~.0DFHRTz|jUj8UjUjPUjUjhUjUjtU jUmHjU jU@P\Fkk|$$IflF4"0    4 la $If !$If ! P\FHVXZxz ( * N r  " $ & : H J n  * 4 f p t v x & ( T | ~                     LFH$IfX$$Ifl4""04 laVX<|$X$$Ifl4""04 la$If|$$IflF4"0    4 laXZxz$If & F$IfX$$Ifl4,""04 la$If ! ( * N r wqqwqqwqqq$If & F$If~$$Ifl4Fl,"<0    4 la * , H J L J L h j l   & ( * 4 6 L N b d f p r    " $ T V j l n x z '(/0160JmH5jTUjUjPU jUmHjU>*j>Uj|UjUjU jUj U>  " nPhhh$If$$Ifl4\ l,"<:b04 la" $ & : H J n L{{{q{{ & F$If$If~$$Ifl4F l,"<b0    4 la {p $If ! !~$$Ifl4Fl,"<0    4 la  8 L t $If !X$$Ifl4,""04 lat v x oic$If !$$Ifl\T l," b04 la & ( T | 6k$$Ifl40 ,"v"04 la$IfX$$Ifl4,""04 la| ~ /PV$$Ifl ,"804 la` $If !k$$Ifl40 ,"v"04 la 1ABCDEF$a$$a$$a$V$$Ifl ,"804 la` $$Ifa$ ()*,-/1>?ABCDEF 67=>?@F0JmH0J j0JU0/ =!"#$%|HH(FG(HH(d'`tDText1DText5M/d/yytDText2tDText6tDText3tDText4tDText7tDText8tDeCheck5tDeCheck4tDeCheck3tDeCheck2Df Dropdown1 Residential Commercial TemporarytDeCheck1DText9$#,##0.00;($#,##0.00)DText10M/d/yyDText11M/d/yyvDText12 i4@4 NormalCJOJPJQJmH 6@6 Heading 1$$@&a$50@0 Heading 2$@&>*<A@< Default Paragraph Font,@, Header  !, @, Footer  !6'@6 Comment ReferenceCJ0"0 Comment TextCJ8Y28 Document Map-D OJQJ&)@A& Page NumberDCRD Body Text Indent0^`0FF4!4 zF((dddg6FFX " t | F  F  &.:@LX^gsy#)=Miy%5 *6<FF4FF4F4F4F4F4F4G G G G S G FFFF46IQX_ag!8@0(  B S  ?FText1Text5Text2Text6Text3Text4Text7Text8Check5Check4Check3Check2 Dropdown1Check1Text9Text10Text11Text12/Mh>j&+G 'A_z*Nz6=G' 06@CDG(06@CDGKendall Crouch&iMac Drive:Documents:City of Earlham 3Kendall Crouch/iMac Drive:Documents:City of Earlham 3 TemplateKendall Crouch/iMac Drive:Documents:City of Earlham 3 TemplateKendall Crouch/iMac Drive:Documents:City of Earlham 3 TemplateKendall Crouch3iMac Drive:Documents:City_of_Earlham_3_Template.dotWELLS FARGO FINANCIAL+C:\Data\Word\City_of_Earlham_3_Template.dotKendall CrouchRdisk 1:Users:kendallcrouch:Sites:www:city_hall:docs:City_of_Earlham_3_Template.dotKendall CrouchRdisk 1:Users:kendallcrouch:Sites:www:city_hall:docs:City_of_Earlham_3_Template.dotKendall CrouchRdisk 1:Users:kendallcrouch:Sites:www:city_hall:docs:City_of_Earlham_3_Template.dotK Cadisk 2:Users:kendallcrouch:Sites:earlham-ia.org:www:city_hall:docs:City_of_Earlham_3_Template.dot  hh^h`.hh^h`.hh^h`)^`)88^8`)^`()^`()pp^p`()  ^ `.@ @ ^@ `.  ^ `.(.BC`g{|+,-<=O`hi{ $%7GNOP{|*>?@CGqu@ !&$!!8l@F@@@ @ @@GTimes New Roman5Symbol3 Arial3Times5 Geneva"1hlF턆`t0!0d7VPrior Approval forKendall CrouchK C Oh+'0  $ @ L X dpx'Prior Approval fordrioKendall CrouchfendCity_of_Earlham_3_Template.dotK C8CMicrosoft Word 10.1@q@:8@PtA@tW.0 ՜.+,0 hp|  'r  Prior Approval for Title  !"$%&'()*+,-./12345679:;<=>?BRoot Entry Ff-.DData 1Table#vWordDocument4SummaryInformation(0DocumentSummaryInformation88CompObjX FMicrosoft Word DocumentNB6WWord.Document.8Root Entry F~-.IData 1Table#vWordDocument\6 d !"$%&'()*+,-./GJLMNOPQRSTUVWXYZ[]^_`abcefghijklmnSummaryInformation(DocumentSummaryInformation8,CompObjX0TableK)!  FMicrosoft Word DocumentNB6WWord.Document.8 ՜.+,0 hp|  'r  Prior Approval for Title Oh+'0  $ @ L X dpx'Prior Approval fordrioKendall CrouchfendCity_of_Earlham_3_Template.dotK C9CMicrosoft Word 10.1@`4<@cW.@PtA@cW.0 i4@4 NormalCJOJPJQJmH 6@6 Heading 1$$@&a$50@0 Heading 2$@&>*<A@< Default Paragraph Font,@, Header  !, @, Footer  !6'@6 Comment ReferenceCJ0"0 Comment TextCJ8Y28 Document Map-D OJQJ&)@A& Page NumberDCRD Body Text Indent0^`0FF4!4 zF(`,-<O`{ $7GOP{|?@G!PS PS PS PS!PS!PSPSPSPSPSPSPSPShPSPSPSPSPSPSPSPSPSPSPSPS!PS!PSPSPSPS!PS!PSPSPSPS!PS!PShPSPShPSPS!PS!PS!PSBC`{|+,-<=Ohi{$%7*>?@G00000000000 00 00 00 000000 0((dddg64FX " t | 4  F UnknownK CKendall Crouch &.:@LX^gsy#)=Miy%5 *6<FF4FF4F4F4F4F4F4G G G G S G FFFF46IQX_ag!8@0(  B S  ?FText1Text5Text2Text6Text3Text4Text7Text8Check5Check4Check3Check2 Dropdown1Check1Text9Text10Text11Text12/Mh>j&+G 'A_z*Nz6=G' 06@CDG(06@CDGKendall Crouch&iMac Drive:Documents:City of Earlham 3Kendall Crouch/iMac Drive:Documents:City of Earlham 3 TemplateKendall Crouch/iMac Drive:Documents:City of Earlham 3 TemplateKendall Crouch/iMac Drive:Documents:City of Earlham 3 TemplateKendall Crouch3iMac Drive:Documents:City_of_Earlham_3_Template.dotWELLS FARGO FINANCIAL+C:\Data\Word\City_of_Earlham_3_Template.dotKendall CrouchRdisk 1:Users:kendallcrouch:Sites:www:city_hall:docs:City_of_Earlham_3_Template.dotKendall CrouchRdisk 1:Users:kendallcrouch:Sites:www:city_hall:docs:City_of_Earlham_3_Template.dotKendall CrouchRdisk 1:Users:kendallcrouch:Sites:www:city_hall:docs:City_of_Earlham_3_Template.dotK Cadisk 2:Users:kendallcrouch:Sites:earlham-ia.org:www:city_hall:docs:City_of_Earlham_3_Template.dot  hh^h`.hh^h`.hh^h`)^`)88^8`)^`()^`()pp^p`()  ^ `.@ @ ^@ `.  ^ `.(.BC`g{|+,-<=O`hi{ $%7GNOP{|*>?@CGqu@ !&$!!8lC$Eƀb'mHnH()*,-/>?BCDEF@@@ @ @@@ @@A4A@@A4AD@A4@^@A4@~@@@@@@@@@GTimes New Roman5Symbol3 Arial3Times5 Geneva"1hlG턆G턆 0!4d7VPrior Approval forKendall CrouchK C@ Fjbjbܡܡ6elvvv 8B ^ ly  $> (f f f E ;L,  pA E vvf f <dv8f f vvvvV|G SeP L/ G\yy; )!)!G Name of Applicant:  FORMTEXT      Date: FORMTEXT      Address:  FORMTEXT      Phone: FORMTEXT      Contractor s Name:  FORMTEXT      Address:  FORMTEXT      Phone: FORMTEXT      Street address and/or legal description of work location:  FORMTEXT       Type of Permit FORMCHECKBOX Water Connection$200.00 FORMCHECKBOX Sewer Connection$200.00 FORMCHECKBOX Street Excavation$100.00 FORMCHECKBOX Curb Cut Permit FORMDROPDOWN $10.00Commercial$10.00Temporary$10.00 FORMCHECKBOX Sidewalk Permit$10.00 Permit Approval Required Before CommencingAmount Paid FORMTEXT      Date Paid FORMTEXT       Inspection Approval Required Before Back FillingDate Inspected:  FORMTEXT      Inspector s Initials: FORMTEXT       I hereby acknowledge that I have read this application, that it is correct and agree to comply with all laws regulating such permits. Applicant or Agent CITY OF EARLHAM APPLICATION AND PERMIT Last updated:  DATE \@ "M/d/yy" 4/29/04 Page  PAGE 1  " nPhhh$If$$Ifl4\ l,"<:b04 la" $ & : H J n L{{{q{{ & F$If$If~$$Ifl4F l,"<b0    4 la {p $If ! !~$$Ifl4Fl,"<0    4 la  8 L t $If !X$$Ifl4,""04 lat v x oic$If !$$Ifl\T l," b04 la & ( T | 6k$$Ifl40 ,"v"04 la$IfX$$Ifl4,""04 la| ~ /PV$$Ifl ,"804 la` $If !k$$Ifl40 ,"v"04 la 1ABCDEF4$a$$a$$a$V$$Ifl ,"804 la` $$Ifa$ ()*,-/1>?ABCDEF 67=>?@F444mH0JmH0J j0JU 0/ =!"#$%|HH(FG(HH(d'`429041