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� - FOR ITY USE ONLY <br /> %�.�I�I��., C'Ity of 01'On0 Date Received: ����(����Permit# ZQ(_"�)-� � � I/, <br /> P.O.Box 66 �—� <br /> ' 2750 Kelley Parkway ❑In-House SAC Detertnination Form omple[ed <br /> i �� . <br /> It:y\l � i;` Crystal Bay,MN 55323 ��C ��- / <br /> � ` (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> /q , ��. <br /> • �tSIiCR , <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 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 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 contractars 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 AIYY 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: 2 � � -5 ��"�u � /� v <br /> Owner: �U`e �L�S � Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> GL� � ��U r-v� <br /> Contractor: '—�(�rr�t-c� f��C C�c v�c��z�Contact Person: �'� � <br /> c <br /> Address: -S v �� ( G���T '`Y�`'��Stat License #: � 3 �� � ��� <br /> City: �!.'�,h�.c�r. f i��`�� Zip:s� ��xpiration Date: � Z - 3 �- �� <br /> Phone: �� Z - �y�--5 35�� Alternate Phone: <br />