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e � � <br /> � FOR CITY,USE ONLY . <br /> ��� City of Or'ono DateReceived .` Permit# ' <br /> O� Q P.O.Box 66 � <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Complete <br /> �`�> ,��. Crystal Bay,MN 55323 <br /> �'��� .��,ja o� (952)249-4600 Approved By(If Required); <br /> t��C�6o$w <br /> asR <br /> CITY OF ORONO—SEWER&WATER/ GENERAL PERMIT S`�� � <br /> (*Note:Some permits may require approval by the Building Officiat and/or Public Works Department*) <br /> (ALL PERMITS D4av be subiect to further review and mav not be issued when thc annlicution is received) <br /> ,_ <br /> �'Vv <br /> GENERAL TNFORIVIATION <br /> r ' <br /> erson <br /> at the Ci <br /> offices. <br /> 1. You may apply for uhhty penruts by mail o uz p ty <br /> 2. Mailed in applications are subject to die postage and handling fee shown below. Pernut cards ill <br /> be sent by rehu7i mail within 2 busuiess days. � <br /> 3. Per�nits are not valid until you receive a permit card. <br /> 4. Woi'k must not begin unless the peinut card is available on the job site. <br /> 5. Urility comiection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locarions. '� <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without ex�'ress <br /> approval of the Public Works Department. Issuance of a perniit does not grant this appro�ral. <br /> 7. All work must be done in accordance with State Code requirements. I <br /> 8. All work inust be inspected before it is covered. Call(952)249-4600,24+hour notice req ired. <br /> . TYPE'OF PERYVIIT <br /> � (GYieck Al1 That A ''ly) <br /> ❑Residential(May Require Approval) ❑ Commercial(Approval Requued) <br /> �New Connecrion ❑Additional Connecrion ❑Re-Connection ❑Repairs ❑Disco ect <br /> Job Site/ Owner Information: �i <br /> i <br /> Site Ad�dress: � ��.� • �ti-���-�'�-,.� <br /> i 3/�s ,��.` <br /> Ownerk�Z���� 4���-n- ���`— Mailing Address: <br /> City: �i% k—��'���1�-- Zip: ���� <br /> � i <br /> Home Phone:c/S�� � Gf�/9'— 9/.S4 Alternate Phone: � <br /> � <br /> Contractor Information: � <br /> , �J ��� <br /> � r n: <br /> Contractor: v�� ���"Contact Pe so <br /> !/� <br /> � <br /> Address: ���U �,.�v��^ State License#: f /�z /� <br /> City: Zip:�7 Expiration Date: � " 3 i ~ � � <br /> i �� � <br /> Phone: ���-�—�7 T�'��S`� Alternate Phone: �/2 �f c�'�� � <br /> I <br />