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� <br />�, <br /> , <br /> � � <br /> FOR�USE ONLY <br /> jg�A�` Clt Of�I'On0 Date Received: �{' Permit# � � <br /> O�r\ Y � <br /> 1,/r� � P.O.Box 66 � AL <br /> �',t,,,,�„ 1 2750 Kelley Parkway ❑In-House SAC Determination Form Completed ,� ��j� <br /> ���.'h�` �� Crystal Bay,MN 55323 � � <br /> '�'��goY�a�' (952)249-4600 Approved By(If Required): �f Zq I� <br /> \.`:.-� � <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- DZav be subject to further review and mav not be issued w6en the aaalication 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 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. 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 A 1 <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: �g00 ��111�rc-J L�-2� <br /> Owner: JL('r�l ,'Lln�v�- F-¢.►�v�p Mailing Address: <br /> c�ry: D�oV10 z�p: 55323 <br /> Home Phone: �2 -�1�o"U232 Alternate Phone: <br /> Contractor Information: <br /> Contractor: Glenn Rehbein Exc, Inc. ContaCtPerson: John Carlisle <br /> 8651 Naples Street NE <br /> Address: State License#: �C��o�g$' <br /> City: Blaine Zip:55449 Expiration Date: /Z 3/ Z�D <br /> Phone: (612) 919-2019 Alternate Phone: (763) 784-0657 <br />