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, <br /> FOR CIiY USE ONLY <br /> +,,;¢0�� CityofOrono Daueeceived: Permic� <br /> s <br /> �1 P.O.Box 66 <br /> �� �� �1 2750 Kelley Partcway ❑In-Housc SAC Deumtirmtion Form Completed <br /> '`��,s, r3 Crystal Bay,MN 55323 <br /> �;�r:�a o��' (952)249�600 Approved By(if Requited): <br /> �¢'y� <br /> CITY OF OROlvO-SEWER 8c WATER/G�;NERAL PERMIT <br /> (`Note:Somc permits may rrquire approvat by the BuiEdieg OfficiaJ anNor Public Works Department') <br /> {AI,i,PERMI'I'S- Mav be aa6ictt to fuHhcr revNx and mav not bc isaacd wben the sndicatio4 a r`eteived) <br /> GENERAL TNFORMATION <br /> 1. You may appty for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shoum below. Permit cards will <br /> be sent by retum mail within 2 business days. <br /> 3_ Permits are not valid unt�l you receive a permit card. <br /> 4. Woric must not begin unless the permit card is availabie on ihe job site. <br /> 5. Utitity conne.ction pertnits may be issued to licensed canVactors only. <br /> 6. Contact the Pubtic Works Departrnent(952-249-4600)for utiiity stub as-built tocations. <br /> DO NOT EXCAVATE IN ANX STREET AND DO NOT TAP ANY MAIN wit6out e:press <br /> appraval of the Pubtic Warks Departmeat. Issuance ofa permit does not grant thes approval. <br /> 7. All werk must be done in accordance with State Code requirements. <br /> 8. All work must be inspecied befo�+e it is covered. Calt(952)249-4600,24+6our notice required. <br /> TY�'E OF PERMIT <br /> (Check All That t1 1 <br /> ❑Residential(May Require Approval) ❑Commercia)(Approva!Required) <br /> ❑New Connection ❑Adtlitionai Connection ❑Re,Connection ❑Repairs D�sconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Wa <br /> Job Site/Owner Information: <br /> Site Address: ����5 {„�'��;Y'" <br /> Owner'�v�c{ '/,�,✓'. V'v Mailing Address: �9a' $E� P� ►2t�,� J��a,c� <br /> ciry: �4jPu. N�?��'-�'e 11�t/� zip: �3'� �v <br /> Home Phone: �a- p`��-O�(o� Alternate Phone: �o�a '�f '�3� �C e��� <br /> Contractor Information: <br /> Contractor: /' 1�.��z Contact Person: C/�' ��`�� ''� <br /> Address: l/�d/ '�� '.z....�j�3 State License#: �lJ�.- 1GN+d'3 #��� <br /> r / <br /> City: /� �i� _ Zip�S�y3Expiration Date: 02�8��/ <br /> Phone: �S� ���1�.� Alternate Phone: t-�'e���'"735� <br />