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FOR CITY USE ONI.Y <br /> �" �� CItV Of�POOO Da[e Received: Pennit# <br /> / ��'��\ P.O.[3ox 66 <br /> ���; �'� 2750 Kelley Parkway ❑In-House SAC Detennination Form Completed <br /> �i�} �f1�` • �i� Crystal Bay,MN 55323 <br /> R-; <br /> '�� � r�o`� (953)349-4G00 Approved I3y(If Required): <br /> �:�°drexo�$.� <br /> CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT <br /> ("`Notc Soine peiniits may rcquire approval by the 13uilding Official and/rn Public�'Jorks Department*) <br /> (ALL NH:R�II'1'S- '�1a��be subiect to further revie�v and ma��not be issued when the apn��cation is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail ar 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 withii�2 business days. <br /> 3. Permits are not valid w�til you receive a permit card. <br /> 4. Worl<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 Works Department. [ssuance of a permit does not grant this approval. <br /> 7. All ���ork must be done in accordance with State Code requirements. <br /> 8. All �vork must be inspected before it is covered. Call (952)249-4600,24+hour notice required. <br /> TYPE OF PERMIT <br /> Check All That A 1 ) <br /> ❑ Residential (May Require Approval) ❑ Commercial (Approval Required) <br /> � New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site /Owner Information: ,��/'�i'��p%� �'a/aG <br /> Site Address: '�' 'J �d''��—%�/ ` _ �� �Z ��--e.�.� <br /> Owner: f,%�5��<�' �rJi1�� Mailing Address: <br /> Gity: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> � '� � ��C��`f.-� <br /> Contractor: �u- ��rS L'.r� Gontact Person: �l <br /> Address: llv�.��/ .����� -STJ'�� State License #: �y �� <br /> City: � i li' Zip;��Expiration Date: ��✓'�� <br /> Phone: ��,�'�l����� Alternate Phone: �1����� <br /> a <br />