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� <br /> FOR CITY USE ONLY <br /> ��,�` Clty of Orotlo Date Received:L ( �t Pern»t# , �X � <br /> O a `rO P.O.Box 66 <br /> (� �,,ti„ 2750 Kclley Parkway ❑In-House SAC Deterniination Form Completed <br /> a j!`:'�,�'�- � Crystal[3ay,MN 55323 <br /> �a �'��'''a o`� 952 249-4600 Approved By(If Required): <br /> t 1,;�,hr��;�y ( ) <br /> '�sexo�' <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 PFR�IITS- Mav be subiect to further review and mav not be issued�vhen the apnlication is received) <br /> GENERAL 1NFORMATION <br /> 1. You may apply for utility pei7nits 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 rehun mail�vithin 2 business days. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the pernut card is available on the job site. <br /> 5. Utility comiection perinits may be issued to licensed conn�actors only. <br /> 6. Contact the Public Works Department(952-249-4600) for utility shib 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 pemut 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+liour notice required. <br /> TYPE OF PERMIT <br /> (Check All That Apply) <br /> �esidential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs �Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: �T T S ,�UN wGQ� �! � <br /> Owner: SiJti/C���T �ui�c`�r�ZS Mailing Address: (�51�;3 ���L.F T i ��-v� <br /> City: /vlo��N� _ Zip: J����`-�4 <br /> Home Phone: Alternate Phone: (,(Z Z�O �-��`�' � <br /> Contractor Information: <br /> Contractor: J `� `��a�Zi ��J��l��S Contact Person: ,�n�i :S�T�w��Z-r <br /> Address: IIU�`t �+/y'orvr v�- State License #: � C�� <br /> City: �/�JNl1VF_� Zip:��{( Expiration Date: �1 �R <br /> Phone: �4� � �f2�1 �1t�3C7 Alternate Phone: fo/Z- ��(�(�' �v8ll <br />