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, <br /> , <br /> F'OR CITY USE ONLY <br /> �p- City Of 01'Ono Date Received: Perniit# _ <br /> O� �vO �'•O.Box 66 <br /> �,,.4,� 2750 Kelley Parkway ❑In-House SAC Detern�ination Form Cumpleted <br /> a� ��j�Fu;��: ��* Crystal Bay,MN 55323 A roved B If Re uired <br /> � 'T�,���,�.�o (952)249-4600 PP Y� 4 )� — <br /> ��KoB <br /> CITY OF ORONO -SEWER & WATER/ GENERAL PERMIT <br /> (*Note:Some pern�its may require approval by the Building Official and/or Public Works Departmert*) <br /> (ALI PFR�'IITS- Mav be subiect to further review and ma��not be issued when the ann��cation is received) <br /> GENERAL 1NFORMATION I <br /> 1. You may apply for utility pennits 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 reriun mail within 2 business days. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work inust not begin unless tl�e pernut card is available on the job site. <br /> 5. Utility comieetion permits may be issued to licensed conh-actors only. <br /> 6. Contact the Public Works Department(952-249-4600) for utility shib 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 pernut 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+liour notice required. <br /> TYPE OF PERMIT <br /> (Check All That Apply) <br /> �Residential(May Require Approval) ❑ Commercial(Approval R_equired) <br /> �ew Connection ❑ Additional Connection ❑ Re-Comlection ❑ Repairs ❑Disconnect <br /> Job Site / Owner Information: <br /> 1 _.7 �� � �vc�1 (.,J c. <br /> Srte Address: � � <br /> Owner: .�v��h��� �c�����5 �(��.�Vlailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: �.J�SC��+ �`' Contact Person: 15/'i1�� �[4�" � <br /> / ..— <br /> Address: ���� CO . �J( (S State License #: � ���� <br /> City: (,�/l��"1 cJ Zip:S���� Expiration Date: �� - �S� �L�-� <br /> Phone: � -2 ���-Z� S� Alternate Phone: �� �� ?��^S ��l <br />