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Y <br /> �=�--., Fo�� us�o�vi.v � ,�/� 3� <br /> ��- �1O�, City of Ol'oao Date Received: _�� Permit# � �) �� l"'� <br /> �' �, P.O.Box 66 <br /> � ' � ` 2750 Kelley Pazkway ❑In-House SAC Determination Form Completed <br /> �-�' Crystal Bay,MN 55323 <br /> �\\��.i',�'�¢j j (952)249-4600/Fax(952)249-4616 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 Departrnent') <br /> (ALL PERMI7'S- Mav be subiect to lurt6er review and mav not be issued when t6e aoulication 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 retum 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 Pubtic 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 /> ❑ Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> � <br /> ❑ New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs �Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Wate� <br /> Job Site/Owner Information: <br /> Site Address: _� � UU �v�� � �U�n-+ ��� <br /> Owner: ���"� �u�,��r�� Mailing Address: �. (-le�h;��a� q�� S ��(v-7 <br /> City: 1�;,.��ua�> > ;� Zip: S SK U� <br /> L c i l � }'��G� <br /> Home Phone: -�1te�ate�Phone: �S l -3U� - <br /> Contraczor Information: <br /> Contractor: (,��I-1, S r w?� 4�L�l�,.�-��r L L(�ontact Person: L3;�1 11����I`CJ <br /> Address: �Z�S TQw.'� �r��✓� State License#: PL6Y���' <br /> City: �u^�c'� Zip:SS 3 YGExpiration Date: l�.' �l " t 6 <br /> Phone: ���-`�l y ��a'y� Alternate Phone: <br />