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N <br /> � <br /> •� FOit 1 USE ONL�' <br /> ��-��10� City of OCono Date Received: '^ n Permit# _� ��a�' <br /> ! •� P.O.Box 66 <br /> � �i, I 2750 Kelley Parkway ❑In-Howse SAC Determination Form Completed �� <br /> ` \1 �-� Crystal Bay,MN 55323 � <br /> �y`\�t.�y�¢j j (952)249-4600/Faac(952)249-4616 Approved By(If Required): <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Departrnent') <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when t6e aoolication is receivedl <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City of�ices. <br /> 2. Mailed in applications aze 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 untii you receive a permit card. <br /> 4. Work must not begin unless the pernut 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 /> approvai 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+6our notice required. <br /> TYPE OF PERIVIIT <br /> (Check All That A pi <br /> ❑Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> New Connection ❑Additional Connection 7[�Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Informati : <br /> Site Address: � ���� G v� <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contraczor Information: <br /> // /( � ' � � i�� <br /> Contractor: � � ���K �(C � Contact Person: � <br /> Address: �J�/`l��-j���'���tate License#: <br /> City: �� �� �� Zip:��'�� Expiration Date: <br /> Phone: � � �� ��/ Alternate Phone: <br />