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' ,.. <br /> .... <br /> 1 <br /> FOR CITY USE ONLY � /� <br /> �l�/�/O' CltyofOrono DateReceived: _i��_ . Permit# �` / <br /> P.O.Box 66 TL <br /> ` , 2750 Kelley Parkway ❑(n-House SAC Determination Form Completed '� �� ,/�� <br /> i Crystai Bay,MN 55323 Ci ,`.� <br /> �'.� � �t� (952)249-4600/Eax(952)249-4616 Approved By([f Required): ,.� �, <br /> � <br /> CITY OF ORONO-SEWER & WATER/GENERAL PERMIT ��`�A <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) � <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when 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 /> R dential(May Require Approval) ❑Commercial(Approval Required) <br /> �,�,/ <br /> �New Connection ❑ Additional Connection ❑ Re-Connection ❑Repairs ❑ Disconnect <br /> j ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: � �/SG G�-ec� ��e{s- /� d ' �a �""�``" �'v -SS �9/ <br /> Owner: C�j�, s Wi"`�Svi'I MailingAddress: -��n�L.-� <br /> City: �q Za ��"� Zip: <br /> Home Phone: ��2 - ��� - �I y9�- Alternate Phone: <br /> Contractor Information: <br /> Contractor: pafin,a.e (s'���"�-s Contact Person: /�`��'� ga��� <br /> Address: � 8y f L��.- ��f� � N'E•� State License #: L 3 8�� <br /> --�.. <br /> City: �'f��'►•��^�-� Zip: 5 f1�� Expiration Date: <br /> Phone: ���-y� y�°'12 Alternate Phone: <br />