Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
.. `'� <br /> � .�L <br /> ,� „ <br /> FOR C T USE ONLY <br /> � � <br /> �0�/O,, Clty Of�['O�o Date Received: __��1��ermit# � <br /> P.O.Box 66 �'Y��i�� <br /> � ` 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> ,"\'��,} ; Crystal Bay,MN 55323 <br /> \"'�^��ti�,` (952)249-4600/Fax(952)249-46i6 Approved By(If Required): <br /> fSN� <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some}�mits may require approval by the Building Of�icial and/or Public Works Department�) <br /> (ALL PERMIT'S- May be subiect to further review and mav not be issacd w6en the aanlication is reeeivedl <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City oflfices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will <br /> be sent by return mail within Z business days. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> S. Utility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stuh as-built locations. <br /> DO NOT F.XCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express <br /> appmval of the Public Works Department. Issuance of a pemut dces not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600,24+hour noNce required. <br /> TYPE OF PERNIIT <br /> Check All That A 1 <br /> �Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑New Connection ❑Additional Connection ❑Re-Connection ❑Repairs �Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: �U�� J��\J n��O c-�_�(�z � �1(`c���� <br /> C.�ntr�;,;- ' <br /> Owner:C,Ycc 1� �l\�.U.S1bm��nr�� Mailing Address: ��� `J� <br /> �vY'�h YtS�r-�-���. <br /> c�ry: �.1��� C rr,v L z�p: �553 I � <br /> Home Phon�����53-�3a� Alternate Phone: 11� �'�5y�" Q`�Xl�c_t�� <br /> Contractor Information: <br /> ��Z..L�1 �-Jt,Y�.z..� �12vr/1�-nC� <br /> Contractor: �2�-ca�jc�„z v�.}-�n,�,� Contact Person: ����� S �2�e1 �r'. <br /> Address:1�-�tiCz,n� 1�0 State License#: -L1�Qa�1,p�1 <br /> City: Zip�3�1�- Expiration Date: �a • 3l• �l al <br /> Phone: �����i��S-��`� � Alternate Phone: ( I D la T�JId�-4�3� <br /> l 1(��1.ay I� ��j�prj�ll� 1-'►�e�r.S�e�- <br /> 1"a ,3� 13 <br /> �►P���s ���.-��a,4o <br />