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FOR CITY USE ONLY <br /> �����/� City of Or'ono Date Received: Permit# <br /> P.O. Box 66 <br /> /�� 2750 Kelley Parkway ❑ [n-House SAC Deterniination Form Completed <br /> �� i , ; Crystal Bay,MN 55323 <br /> .�k� ����� (952)249-4600/Fax(9�2)2a9-4616 Approved By(If Required): <br /> tii�� <br /> CITY OF ORONO —SEWER & WATER/ GENERAL PERMIT <br /> (*Note:Some permi[s may require approval by the Building Ofticial and/or Public Works Department*) <br /> (ALL PERM17'S- �tav be subiect to further review and maV not be issued when the ann��cation 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 applications are subject to the postage 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 must 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 Works Department(9�2-249-4600) for utility stub as-built 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 Apply) <br /> �Residential (May Require Approval) ❑ Commercial (Approval Required) <br /> �New Connection ❑ Additional Connection �Re-Connection ❑ Repairs ❑ Disconnect <br /> ❑ Water Availability Conn c ion For Future Hook-Up to Water <br /> Job Site / Owner Information: <br /> Site Address: 'J���� ���C'� ���'C',�G� <br /> Owner: �f�"JG�� ��'�'Q"5' Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> � ` � � ,�/� ��'►K' � � ,C'�- C���'�`�/�''��� <br /> Contractor: �,��� L%��`�� Contact Person: <br /> � <br /> Address: G'�/L ����'%��= � State License #: <br /> City: ���C�� Zip: �v���Expiration Date: <br /> /,� ��� ` � � � � � <br /> Phone: ��� 7��"���� Alternate Phone: (� Z ��� ��`� <br />