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. <br /> • FOK CITY USE ONLY <br /> ��� C'tty of OCono Date Received: Permit# <br /> P.O.Qox 66 <br /> ��j�, � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �{�J <br /> a �j ,�� Crystal Bay,MN 55323 <br /> � �(,��''�o`� (952)249-4600 Approved By(If Required): <br /> ��t?��'��� <br /> asxa <br /> CITY OF ORONO —SEWER & WATER/ GENERAL PERMIT <br /> (*Vote:Some permits may require approval by the Building Ofticial and/or Public Works Department*) <br /> (ALI PFRMITS- h9aV be subiect to further review and mav not be issucd when the application is received) <br /> GENERAL 1NFORMATION <br /> 1. You may apply for utility pennits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee sho�vn below. Pernut 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 inust not begin tmless the pern�it card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed conhactors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility shib as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP AIVY MAIN without express <br /> approval of the Public Works Department. Issuance of a pernut does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirernents. <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 Apply) <br /> ❑ Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> �] New Connection ❑ Additional Coimection ❑Re-Connection ❑Repairs ❑Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: �J �G � <br /> � <br /> Owner: �� C v� Mailing Address: <br /> c�ty: � l/1 z�p: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: �1 (��'� � ��C Contact Person: a g P��i-� <br /> Address: State License#: <br /> c�t �= ��I �. <br /> y: ��'( �� r � � Zip:�S xpiration Date: <br /> � <br /> Phone: _��� �'� �� l Alternate Phone: <br />