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FOR CITY USE ONLY � �- <br /> � ,��� Clty of OCOnO Datc Received: �'�I Permit#��� <br /> O O P.O.Box 66 �— <br /> ��-,,� 2750 Kelley Parkway ❑ [n-House SAC Determination Form Completed <br /> � ��'�°����. P� Crystal Bay,MN 55323 G�i <br /> ����.�o�� (952)249-4600 Approved By Qf Required): �, ����, . <br /> CITY OF ORONO —SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subicct to Turthcr review and mav not be issued when the apn�ication is received) <br /> GENERAL 1NFORMATION <br /> 1. You may apply 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 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 connecrion permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600) for utility stub as-built locarions. <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 befare 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 /> Job Site/ Owner Information: <br /> Site Address: �'�� � � ��'r I < <' �� r.-, -� ��• << </ <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractar Information: <br /> Contractor: /�r�-�f � �x��� ��_ ��n j Contact Person: � � '�' � �` � ��r <br /> -3 -� 3 r <br /> Address: rc �''r� �`'F"'`' �`f !?! State License#: <br /> �rY� 7 <br /> City: �r�'� �� � Zip: Expiration Date: <br /> Phone: 7� 3--sy Y1"- 31's- 7 Alternate Phone: G� '7- � �s_- ��� � <br /> �' C, r�s c�// <br />