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r , <br /> _. ��ncv �O/S ///7 <br /> ' �..'��t�'�., City oif Qrono Dute Rcceive . � !'ermit:�i <br /> P.Q.Hox 6G <br /> � 27SA Kelley Parkway ❑Tn-House SAC i3et�rmination Fartn Campleted <br /> -�4�, , � ' Crystai Bay,Mirt 55323 <br /> �•�'f�r� +.' " (952)2�4-46UQ J Fa�c(9S2)249-4616 ApProxed By(If'Required}: � <br /> .�'�24eiti?�-F..: .,. . . . . � . <br /> CITY OF ORC3NQ-SEWER&WATER 1 GENERAL PERNIIT <br /> ('*Note.Satne perntits rcaay r�quire approval by fhe Bn7ding Officiai aniUor Public Works Department") <br /> (�[t PERMITS Mav be subject to furthsr revietir awd m�y aot be iscu�d rr6en the apiulicakioe is receivedl <br /> ' tiENERAL II�iF(7�R.MATCQN <br /> 1. You may apply for utility permits by mail or in person at the Gity offices. <br /> 2. Mailed in applications aze subjec#to the}'s�stage 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 /> S. Utility connection permits rnay be issued to licensed cantractars anly. <br /> 6. Contact the Pub}ic Works I3�p�rtment(952-249-46U0)for utility stub as-buitt locations. <br /> DQ NOT EXCAYATE IN ANY STREET AND DU NOT TAP ANY MAIN withaut express <br /> approval ofthe Public Warks.Department. Issuance of a perrnit does not grant ihis approval. <br /> 7. All work rnust be done in accordance with State Code requirements. <br /> 8. AU wark must be inspected before it is covered_ Calf(952�249-4&Q0,24+bour notice required. <br /> TYP�OF FERIVII;T <br /> Check AIl Th�t A 1 <br /> �esidential{May Ftequire Approval) ❑Camrt3ercial{Approva]Required) <br /> �ew Connection ❑t�dditional Connection ❑Re-ConnecCion ❑Repairs ❑Disconnect <br /> �1 ❑ Water Availabil'zcy Cannectian Fvr Future Hook-Up to Water <br /> Jvb Site 1 Own�r Int'armation: <br /> Site Address: � <br /> � � � �� ���� <br /> Owner: � „�(��(,�� Mailing Address: <br /> City: �i�„� �� Zip: �-���/f <br /> � <br /> Home phone: Alternate Phone: ~,�� " _"���S <br /> `'Ca�tractar Infors�iation: <br /> Gontractar: ���.�„C , -fX' �����t Person: �l� �<�- <br /> � j��� <br /> Address: ������`���� �j� �tate License#: <br /> 9�� <br /> City: ��,�"�- Z�p�.����Expiratian I7ate: � <br /> Phon�: � '��'��-'���� Alternate Phane: ���� ��""� I�c� <br />