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f <br /> - F� CITl U}5E ONLY �� <br /> �� Q�-U1,I��� City Of OrOno Date Received Permit# ot�/5 '� <br /> P.O.Box 66 <br /> �� l �! 2750 Kelley Pazkway ❑In-House SAC Determination Form Completed � <br /> f`'�y\, � �% Crystal Bay,MN 55323 � <br /> \����+�IiSH.�������/' (952)249-4600/Fax(952)249-4616 Approved By(ffReqaired): �,J <br /> ��____., <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMIT5- Mav be subiect to further review and mav not be issued when the aaolication 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 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 Warks 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 accardance with State Code requirements. <br /> 8. All wark must be inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> TYPE OF PERMIT <br /> (Check All That A ly) <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> / <br /> � New Connection ❑ Additionai Connection ❑ Re-Connection ❑ Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: /��� ��/V�TC/✓� <br /> Owner: ���r'�� �I��������fv Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> .-� � � 1 <br /> Contractor: �1 � f • �����L���Contact Person: ��'� <br /> U / �i <br /> Address: ��j7�� �17��Y�/� State License #: <br /> �,� i � <br /> City: ���`� �'���Z� Zip�'7�� Expiration Date: Z l� <br /> Phone: �6J/ ��'Z/ �`�� Alternate Phone: �C/� �U�✓` l �� <br />