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1964 Safari Tr - Landscape GuaranteeAmount: its Authorized by: City a(Eayll ENGINEERING DIVISION -/) /6/ DEPOSIT INFORMATION (Attach check / submit to Building Inspections for receipting) Property Address: tq b4 ca(n; Tr 9001.2257 Financial Guarantee Grading Permit No. EX 9001.2257 Financial Guarantee Right -of -Way Permit No. RW REFUND INFORMATION (Attach copy of check & receipt / submit form to Sue Sheridan, Finance) Refund Date: Payee Name: (1l;Kk L,�,rSov1 Address: I c7 4 c 7r Reason for Refund: Comp /E G:FORMIS /Financial Guarantee Deposit Form (blue) 06 -05 -07 Date: ...S //1 st 4'f% Pt,'M"- A, 9 Right -of -Way Permit No. UT Check #: I Soc Amount: ,cs"6o // A t�Z. 2it2A .9 Receipt Date Receipt Number City of Eagan Cash Receipt MICHAEL LARSON /CK #3219 1964 SAFARI TRAIL 9001.2257 LANDSCAPE GUARANTEE Total Receipt Amount 121197 6:32:53 5/2/2011 169172 500.00 500.00 17 -2/910 173100377030 DATE KA. wttelLet ca. 15866 v fte."1 - o1p /lla, Wtw 55124 ,4,a j og', Five Sta Service Gua ranteed 1 TO MEMO usbank.com 1:09 L0000 2 21: 17 3 1003 7 70 3011