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� FOR CITY USE ONLY <br /> ��� Clty Of Oi'on0 Date Received: Permit# <br /> P.O.Box 66 <br /> ��y � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> a '�)����L � Crystal Bay,MN 55323 <br /> �et�'��h�ijl��o~ (952)249-4600 Approved By(1f Required): <br /> '�Eexa� <br /> CITY OF ORONO — S�WER & WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Ofticial and/or Public Works Department*) <br /> (ALL PERMITS- Niav be subiect to further review and mav not be issued when thc apnlication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pennits by mail or in person at the City offices. <br /> 2. Mailed in appiicarions are subject to the postage and handling fee shown below. Pernut cards will <br /> be sent by rehirn mail witl�in 2 busuless days. <br /> 3. Permits are not valid until you receive a pernut card. <br /> 4. Work must not begin unless the pemut card is available on the job site. <br /> 5. Utility coimection pernuts may be issued to liceused conhactors only. <br /> 6. Contact the Public Works Department(952-249-4600) for utility shib as-built locarions. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN�i�ithout express <br /> approval of the Public Works Department. Issuance of a pemut does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> S. All work must be inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> TYPE OE PERMIT <br /> (Check All That ApP1Y) <br /> ❑ Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> [�I�Tew Connection ❑Additional Comlection ❑Re-Connection ❑Repairs ❑Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: l� � r'�� �v ��l �d <br /> Owner:�'l ' . iA)0'C�, [�U i t�cv'S Mailing Address: �`�� ���. 'i n.�. �'_ <br /> City: � r�fla `1'0�1�� Zi�: �J�_��� <br /> Home Phone: �J�v�•' 7 � � "��� Altemate Phone: ���'���' � �rv� <br /> Contractor Information: <br /> f� --1- 1 �/�' C, <br /> Contractor: ,�J , � I �y�-.Contact Person: C_...6�r��� 6�1 cJ�'S <br /> Address: � �6L` �� �i1�� State License #: �-� r�c�' <br /> City: �.✓jm -�2 � Zip:�-��Expiration Date: �� —� 1 ����� <br /> Phone: (�l� ��!� �G�� Alternate Phoile: ��� J^ � �O ��O �� <br />