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. <br /> t <br /> FOR CITY USE ONLY <br /> /,���.� City Of�ConO Date Received� Permit# <br /> �Y <br /> ��� ��� P.O.Box 66 <br /> �,Gs y 2750 Iielley Parkway ❑In-House SAC Determmat�on Form Completed <br /> '�� �� �<�":. �hf Crystal Bay,MN 5�323 <br /> ���{���}.,�G`/ (952)249-4600 Approved By(If Required): <br /> �oe.� <br /> ����. <br /> CITY OF ORONO—SEWER & WATER/GENERAL PERMIT <br /> (*Note�Some permits may require approval by the E3uilding Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and ma�°not be issued when thc auplication 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 /> spproval 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 ootice required. <br /> TYPE OF PERMIT <br /> (Check A11 That A 1 ) <br /> Residential(May Require Approval) � Commercial(Approval Required) <br /> � New Connection ❑Additional Connection �Re-Connection �Repairs �Disconnect <br /> •�1.' <br /> Job Site/Owner Informati�n:���4 �� <br /> . ��,��� , <br /> Site Address: `�1�� '��� 7 � �� f � j�c�� ��;r�;� �C;� <br /> Owner: �`'Ic�^ �f� 1—�G��1:L:4^x� Mailing Address: �_, ��C:; <br /> City: �� ���v����', I �1 , �)� Zi � 3 <br /> P� 5S I�, <br /> Home Phone: Alternate Phone: <br /> Contractor Infonnation: <br /> Contractor: �C�4"�'' C.L,f/15'� Contact Person: �►r-cik ����r <br /> i�'�, <br /> Address: :��% �I�t�S �Jn�c State License #: ,,L � � � <br /> M�`; . 3:�8 <br /> City: ��(c�vt�;� Z�p: •,;5� Expiration Date: (�1_— .�GC, `� <br /> Phone: 7�3- y 7:,� '�(�G� Alternate Phone: �� � � 7C�( � �( 7 Z?I <br />