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RECEIV�C� <br /> ----� MAY 31 2017 FQR c�Tx vs�Q��,� ���-�� �'�� <br /> '�l�t� City of Qrono AateReceived: Perutit#���'—,�,,,-- <br /> � P.O.Box 66 <br /> 2750 Kelley Parkway ���(QF ORONO ❑In-House SAC Detetmination Fonm Completed <br /> y � Crystal Bay,MN 55323 :Q <br /> "�,� p��� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> �CSHn � <br /> J <br /> CITY qF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aonlication is receivedl <br /> GENERAL INFORMATICIN <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 /> 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 QF 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 /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Jab Site/Owner Information: <br /> Site Address: �� �r'��t � w�--+�-�' � t— <br /> Owner: �����c��.f-.e..- Mailing Address: <br /> City: �r� �-�- cy Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> � ��` ' <br /> Contractor: � �r ��� �^-S Contact Person: ,/"l�� ��'�--•-�� � <br /> Address: ��y° � �� e-� 3 State License#: �� t(`��{ �"3 <br /> City: K�P�`''�S Zip:S S 3`r3 Expiration Date: � 2'.��- ��' <br /> Phone: y SZ y�� '���� Alternate Phone: �� 2 `�3 `� 2`�s`1 <br />