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DocuSign Envelope ID: 454AC100- 1926- 4795 - 13946- 86138133246CC0 <br />e <br />TOWN OF CHAPEL HILL <br />ZONING COMPLIANCE <br />Planning Department <br />PERMIT - WIRELESS/ <br />405 Martin Luther King Jr. Blvd <br />phone <br />(919) 968 -2728 fax (919) 969 -2014 <br />COMM, FACILITY <br />www.townofchapelhill.org <br />Parcel Identifier Number (PIN): Click here to enter text. <br />Date: 11 September 2017 <br />Project Name: OWASA — Agua La Vista AM I Project <br />Property Address: 101 Purefoy Dr <br />Zip Code: 27516 <br />Zoning District: Chapel Hill Street /Cross Street: Rogers Road <br />900 Mhz ISM AMI System <br />Project Description: <br />"�JI i t_Q ,• ®P & H1 <br />3k ..x'iYev'1'�� -' ':.ttx <br />Any persons intending to construct, install, remodel, repair, or alter any property in Chapel Hill, may be required to obtain a <br />Business /Privilege License. The application can be found at: http:// www. townofchapelhill.arg <br />/index.aspx ?page =1199 Please <br />contact the Revenue Collector, 919 -968 -2759, if you have any questions. <br />Applicant Information: (to whom correspondence will be mailed) <br />Name: John M Krumenacker <br />Business Name: Mueller Systems <br />Address: 10210 Statesville Blvd <br />City. Cleveland State: NC <br />Zip Code: 27013 <br />Phone: 704- 278 -2221 Email: jkrumenacker @mueller <br />The undersigned applicant hereby certifies that, to the best of his knowledge and belief, all information supplied with <br />this application is true and accurate. <br />Signature: Click here to enter text. <br />Date: Click here to enter text. <br />Owner /Contract Purchaser Information: <br />® owner ❑ Contract Purchaser <br />Name: Orange Water and Sewer <br />Address: 400 Jones Ferry Rd <br />City: Carrboro State: NC <br />Zip Code: 27510 <br />Phone: (919) 9684421 Email: ttaylor@owasa.org <br />The undersigned applicant hereby certifies that, to the best of his knowledge and belief, all information supplied with <br />this application is true and accurate. <br />Signature: <br />Date: Click here to enter text. <br />Page 1 of 3 <br />