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• �_�....� FUI2 CTI'Y USE ONLY l` �` 'J�' <�, <br /> ����10� City of Ol'ono Date Received: t` � �•-� Permit# 7�' ��� <br /> �' •, P.O.Box 66 �- <br /> 2750 Kelley Parkway ❑In-House SAC Determination Form Completed (;� � <br /> �' � ,Z-�' Crystai Bay,MN 55323 �(;` <br /> \`\\A�.c'�(�j� (952)249-4600/F�(952)249-4616 Approved By(if Required): `;�'�� �i �����r` 1�\�l�% <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT ��J <br /> (*Note:Some pertniu may require approval by the Building Official andlor Public Works Departrnent") <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued wheo t6e aoolicallon is receivedl <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 retum 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 pernvt 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 Deparnnent(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. 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 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 /> S�4„��_� ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner information: <br /> Site Address: \y��, L,�'� M t,` �=r�1�� fJ�,l� <br /> Owner:1� � (, ���L��,..,+.5 Mailing Address: o�t���\�;JM1�.�;��Auz r� <br /> City: ,�..'�n�,�.�.�'. s zip: S�`�C`3 C <br /> Home Phone: fa\�,��� -��� � Alternate Phone: <br /> Contractor Information: <br /> Contractor: Cc��(;:,. SW„L a-���;al�� Contact Person: �,;�� (`f;�� p�1 <br /> �— <br /> Address: ��,� 1;c�1.,�►c�T State License#: �i 1����,�R <br /> City: �y�s�-�t�A.ci;;� Zip:�43�� Expiration Date: ���1-\� <br /> Phone: �C\�.�_ -,� -��l L1 Alternate Phone: <br />