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� <br /> � Fou c�Tv L�sF o�vi.v��.�� p�'-� , <br /> �,.,���-��f�I�.-��, Clty Of 01'On0 Date Received: � e' Yennit# E_��-��==-�� ��}JZ""� <br /> P.O.Box 66 <br /> l � 2750 Kelley Parkway ❑]n-i�ouse SAC Determination Form Completed <br /> �ti r f Crystal Bay,MN 5�323 <br /> �?�'"�� �`'� � (9�2)249-4600/Fa�(952)249-4616 Approved I3y(If Required): ��� <br /> ��.Es:= <br /> > <br /> __ zG ��. <br /> CITY OF ORONO—SEWER & WATER/GENERAL PERMIT �µ� P�' OC's� <br /> (*Note:Some p�rmits rnay require approval by the E3uilding O(ficial and/or Public Works Department*) � <br /> (A1,L PF.RMITS- Mav be subiect to further revie�v and mav not be issued when the aoplication is received) �(Zp�15� <br /> GENERAL INFORMATION <br /> l. You may apply for utility permits by maif or in person at the City offices. <br /> 2. Mailed in applications are subject to the postabe and handling fee shown below. Permit cards will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work�nust not begin unless the permit card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Warks Department(952-249-4600)for utility stub as-b�iilt locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express <br /> approval of the Public Works Department. Issuance of a permit does 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 notice required. <br /> TYPE OF PERMIT <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: ` � � � iC w�'+� �� `v� ' <br /> Owner: `�s c�a �� �c� <� Mailing Address: � l l'7 �(uc, C��r , <br /> City: U�����- Zip: <br /> �-rz,3 Y S c�s-�3 <br /> Home Phone: ' Alternate Phone: <br /> Contractor Information: <br /> Contractor: �`�'(��G � �'''s � Contact Person: �� l��`'�� <br /> Address: �l�G � � r��' 3 State License #: � 'J �<�� � � � <br /> 3 �� <br /> ( — t <br /> City: ��'�-' Zip: S� `��Expiration Date: � � � <br /> �s�— � � _� � / c2 —���� —s--Q ��7 <br /> Phone: �-��' � -�-5 Alternate Phone: v <br />