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From: OS/20/2015 10:�8 #797 P.002/003 <br /> 1 <br /> ' FO C1TY tiSE ONLY <br /> ��}�`���`--.. CII�'O��COtlO DateReceived �; (C�'ermit# �-�._ '��>'�t��� �� <br /> i� P.O.Box 66 � <br /> I �4` 2750 Kelley Parkway ❑in-Iiouse SAC lletennination Fonn Completed <br /> „\, � �:; Crystal I3ay,MN 55323 �/� � <br /> . <�.. ��.' (95?)249-4600/Fax(952?249-4616 Approved B (If Re uired): L/ �� � <br /> ��. �ri�{�,o-� �� '`��� �����(v e. � � <br /> 3� �---�— <br /> CITY �F ORONO— SEWER & WATER/GENERAL PERMIT <br /> (*Note Some permits may require appro�al by the Building Official and/or Yublic Works Department•) <br /> (,1LL PERMITS• Mav be subiect tu furf6er review and mav not be issued w6en the upplication is recei�ed) <br /> GENERAL II�IFORMATION <br /> 1. You may apply for utiliry permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee show�n below. Permit cards will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are uot valid until you receive a permit ca►•d. <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 /> b. Contact the Public Works Department(952-249-4600)for utility stub as-buitt locations. <br /> DO NOT EXCAVATE I!�'ANl'STREET A',��DO NOT TAP A�TY 11�[AIN without express <br /> approval of the Public Works Departmenk Issuance of a permit does not grant this approval. <br /> 7. All�vork must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call(9�2)249-4600,24+hour ootice required. <br /> TYPE OF PERMIT <br /> Check All That A 1 ) , <br /> ❑Residential(May Require Approval) ❑Commercial(Approval Required) <br /> �]New Connection ❑ Additional Connection ❑ Re-Connection ❑Repairs Disconnect <br /> ❑ Water Availability Connection For Future Hook-L1p to Wat� <br /> Job Site/Owner Information__ —� <br /> Site Address: � � 5 � �� � ��C �[`�' I � �C�_�„r <br /> 5fire-e-�tY �s n G c�.�c. . � <br /> Owner� S Mailing Address: ' �3 I�.... Y���n� <br /> c��� �o��r �,c��-- z�p: 5539 � �31Yd- <br /> Home Phone: Alternate Phone: <br /> Contractor lnformation: <br /> – �rVl�� ( <br /> Contractor� ��SpV�is L��l!� Contact Person: �l 01(1 <br /> Aaa�s�°3$ �m�s S� �C state �,���°'�' len� _ f yL i�5� (��{-� <br /> �Y�st- t.�-�c¢.� �55u?� .� <br /> City: �p: Expiration Date: � �J ( �S <br /> Phon��IJ ��y 2'a�� Alternate Phone� ��1 Z� g '"� U�J � <br />