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� <br /> FOR CITY USE ONLY <br /> ��� Clty of OCOno Date Received: Pern�it# __ <br /> O s Q P.O.Box 66 <br /> �,,.;�„ 2750 Kelley Parkway ❑In-House SAC Detem�ination Form Completed <br /> a �;�r'' � Crystal Bay,MN 55323 <br /> 'a ��?�j1�'ri�. a~ 952 249-4600 Approved By(If Required): <br /> t T,.S .,;�w ( ) <br /> '�sea�e <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 PERNiITS- Mav be subiect to further review and mav not be issued when the aonlication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pennits 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. `Vork must not begin unless the pemut card is available on the job site. <br /> 5. Utility com�ection permits may be issued to licensed conri•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 pernut 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 /> ( � <br /> �w Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑Disconnect <br /> Job Site / Owner Information: <br /> , <br /> Site Address: ���� �E'��'�`c <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: <br /> ���"1 � � C.-� Coiztact Person: l�1���->� L1�•'" � <br /> / � <br /> Address: �� �U ��( �� State License #: ` ���� <br /> City: ���✓I,C� Zip:���ExpirationDate: �� 31�d <br /> � <br /> Phone: C�.�,l�f 7� "y`� � Alternate Phone: ��-� 7 �l ��� <br />