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FO Tl' 1SE ONLY <br /> ""���``�� Clty of Or'ono Date Received: � �crmit# o�OJ�`� � <br /> !O4 `�'O�\ P.O.I3ox 66 <br /> 3750 Kelley Parkway ❑In-House SAC Detennination form('ompleted <br /> � ,»ti � �*��' Crystal 13ay,MN 55323 <br /> � ''-t r�o��� (952)249-4600 Approved[�y(If Requircd): <br /> �<aQrexoe., <br /> CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT <br /> (*V'otc Somc permits m�y rcquirc appiaval by the I3uilding Otticial and/or Public Works Dcpaitmcnt*) <br /> (AI.1.PEIZJII'I'S- Vlav be subiect to further review and ma��not bc issued�r�hen the annlication 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. [ssuance 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 /> �New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site /Owner Information: <br /> Site Address: ���S ���% �,Q 5 � �n J <br /> , <br /> Owner�� V, �`�'�� '�— Mailing Address: �/S S/�Qr, I`� �� 1,,.; <br /> � <br /> City: �i�� i,�► � Zip: SS s' � f <br /> Home Phone: �S�- � y7 j � �f=lv� Alternate Phone: <br /> Contractor Information: <br /> Contractor: ��rz��� ��-w�,a�l. �-� Gontact Person: � ✓' <br /> Address: ��7'5���,� �/L State License#: <br /> Gity: f��.fM-�'� Zip�y� ExpirationDate: <br /> Phone:�� � �7 F - �"7/ Z� Alternate Phone: ��Z - z `� �, ���� S� <br />