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. _ , � <br /> P'OR CITY LiSE ONLY <br /> �� Cit Of O►'ono Date Received: Permit# <br /> j.:=�(�',`. Y <br /> � g � �� P.O.13ox C6 <br /> ,� ��'�;� 27�0 Kelle�Parktica� <br /> , , y y ❑Iu-House SAC Detennination Form Complefed <br /> 1� qa,'�_ �.� Cp�stal Bay,MN 5�32� <br /> ��\�:,`�,;i,.��;P�c`;i (952)2d9-'Y600 Approved[3y(It'Requircd): <br /> �.KEsxo.. <br /> CITY OF ORONO—S�W�12 & WATER/ GENEI2AL PERMIT <br /> (*Note:Some�ennits may requirc appro��11 by thc[3uilding Ot�ficial and/or Public Works Departincnt*) <br /> (r\LL PGR�'(ITS- i�'iav be subiect lo furfher review o�nd m��y nof be issuccl wlien�I�c.i[�plication is recei��ed) <br /> G�NERAL INI=ORMATION <br /> L You n�ay apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications are su�ject to the postage and handling fee sho���n belo��,�. Permit ca�-ds will <br /> bc sent b�� return mail �vithin 2 busincss days. <br /> 3. Permits arc not valid uutil you receive a permit card. <br /> �. Worl:must not begin unless the permit card is available on the,job siYe. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> � 6. Contact the Public Worl:s Dc-plrtment(952-249-4600)for utility stub as-built Ic�catioi�s. <br /> DO NOT��CAVATE IN ANl'STRGET AND DO NOT TAP ANl'NIAIN without cxpress <br /> app�roval of the Public 1Yorl:s Dep.u•t►nent. Issuance of a permit does not grant this approval. <br /> 7. All worl:musc be donc in accordance�vith State C.ode requirements. <br /> 3. r111 �vorl. must be inspected bcfore it is covercd. Call(9�2)?49-�1600,24+hour notice requirecf. <br /> � TYPC OF PERNIIT <br /> (Checl<All That A 1 ) � <br /> � Residential (t��tay IZeql�ire Approval) � Commercial (Approval Required) <br /> � Ne��r Connection I� Additional Connection � Re-Connection �[]] Repairs � Disconnect <br /> Job Site/ Owner Information: <br /> Site Addcess: ���� �.rGo ,�� <br /> G�vner:, �� i/f�i����� ivlai liny Acidress: �z�7� �9����vG <br /> City: �� /�-��.T/�/� 7ip: �/�c?/ <br /> Home PlZone: �'SZ•Z�Z -31�� Alternate 1'hone: `---'�'� <br /> COtll['3C101' Illf01'lllal1011: I <br /> i . � <br /> Contractor: ..,,�.s, ��,-���� Contact Person: <br /> ��,� � ��� <br /> Address: Z�j/� �Zc ��J��� State License #: /��� <br /> City: l�c��r�— 1 ip:���piration Date: �G�'p <br /> P11onc: �,���,� —����Alterllate Pllone: <br />