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FOR CITY USE ONLY <br /> ����� C'lty Of�l'0110 Date Received: Permit# . ��1 <br /> f \� P.O.Box 66 " �\� � <br /> ����, ��� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed ��.� � <br /> �` �; Crystal Bay,MN 55323 ��- <br /> ���� '���� , o;;� (952)249-4600 Approved By([f Required): �� <br /> ��0��" '��� � <br /> -=. _ „ <br /> L <br /> CITY OF ORONiO-SEWER& WATER/ GENERAL PERMIT l �,1� <br /> (*Note:Some permits may r�equire approval by the Building Official and/or Public Works Departmcnt*) � <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoplication is received) <br /> GENERAL INFORMATIOTI <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 connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)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 V1�orks Department. Issuance of a permit does not grant this approval. <br /> 7. All wark 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 /> �'�esidential (May Require Approval) � Commercial(Approval Required) <br /> ❑ New Connection ❑Additienal Connection Re-Connection ❑ Repairs � Disconnect <br /> Job Site/Owner Information <br /> Site Address: � 9 � 3 � a s� o f�� ' K f p�o � �/ <br /> Owner: n�� ��' ��` � ``�r �� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> ,� '_ � �' � � �'^ � � �, <br /> Contractor: �"'' �� <-X�G�� �'� Contact Person: � ' ' <br /> Address: �3�r /G~~r,i��.���4 AN State License #: <br /> r4�?� <br /> City: �� y' �G � Zip: s Expiration Date: <br /> 6� �_ � or._ 3 �0 � <br /> Phone: Alternate Phone: <br />