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•' aolt-ooy2b <br /> v <br /> FOR CITY USE ONI.Y <br /> �Q � CI[V Of�1'OIIO Date Received: Pennit# <br /> r 4 �t P.O.Box 66 <br /> \ <br /> � .i; 2750 Kelley Park��ay ❑ fn-I louse SAC Detennination Forni Completed <br /> � �i:� �' �*;� Crystal Bay,MN$j323 <br /> �� ,r •$o`;� (952)249-4600 Approved By(If Required): <br /> �aaxo�' <br /> CITY OF ORONO–SEWER & WATER/ GENERAL PERMIT <br /> (*Note:Some pennits may require approval by thc[3uilding Official and/or Public Works Department*) <br /> (AI,L PERJII'I'S- M:n�be subiect to further review and m:���not be issued�r�hen the aonlication is receivetl) <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 Uepartment(952-249-4600)for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MA1N 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��ith 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 I ) <br /> �Residential (May Require Approval) ❑ Commercial (Approval Required) <br /> ❑ Ne��� Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> ❑ Water Availability Connection For Future Hool<-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 'J� ' � � `�, � � C� �� <br /> � � <br /> ti�� � <br /> Owner: �Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Inforn�ation: _. � <br /> \.___ - <br /> ; <br /> Contractor:���J � Contact Person: <br /> C �,�-- r. Q / <br /> Address: � �7 ����G�-��(����,(��tate License #: v S U ��(U —�/�"/ <br /> �-- - v / <br /> City: �� � Zip��� �xpiration Date: � � / � <br /> �� <br /> Phone:��� Alternate Phone: � G� � �� <br />