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r <br /> . � � <br /> FOR CITY USE ONLY <br /> 4�,�` Clty Of�COno Date Received: Permit# <br /> `r P.O.Box 66 <br /> �"� � 2750 Kelley Parkway <br /> ��; ❑In-House SAC Determination Form Completed <br /> a 1�'��r,. � Crystal Bay,MN 55323 � <br /> �d��y��'��;�.�o` (952)249-4600 �Approved By(If 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 PF,RMITS- Mav be subiect to further review and mav not be issued when the application is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mai] or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Perniit 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 pemut card is available on the job site. <br /> 5. Utility connection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Deparrinent(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. 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 Connection For Future Hook-Up to Water <br /> � Job Site / Owner Information: <br /> Site Address: �� � ���5��..� �v� • <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> , '��!� G� <br /> Contractor: ��-�'���G���G ���'� �'`�Contact Person: �Fi 4�'� C�c i�� / <br /> Address: �5�� ��� ��� �S� State License#: <br /> City: j���*�� `" Zip:s��' T Expiration Date: <br /> Phone: C��-�-( ?-Z-�(S,b� Alternate Phone: �'�� 7y�- �7�cT C C��� <br />