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. v��3Z <br /> , <br /> � 1� <br /> FOR CITY USE ONLY � <br /> "� '� Clty oF 01'ono Date Received: � ��nit# <br /> „��� ���� P'O.Box 66 � � <br /> � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �� y�� �` �`�� Crystal Bay,MN 55323 �2� <br /> �� � , r,o�: (952)249-4600 Approved By(IfRequired): <br /> .:�!a�xoe�; <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 PERMITS- Mav be subiect to further review anU mav not be issued when the aoplication is received) <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 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 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 /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 015 MT�1�►.�p�� i2 t� <br /> Owner: 5��p v�_ 12��,.� Mailing Address: �,S M�vr�1 ew�n a �0 <br /> c�r�: a�-�,n� z�p: 5 s 3 a 3 <br /> Home Phone: �5�,'��,3•' l�7� Alternate Phone: �r,1 a��C 3"(��I 7 p <br /> Contractor Information: <br /> Contractor: Le�1 SQw�, i w«h�e�� Contact Person: [�:1� C.o,op::� <br /> Address: S56�I f,�y,� `_�,,G�� State License #: �1 �� �1 -M, (�L <br /> City: 1,vv.1e�}n,..,� Zip:S_�3`d� ExpirationDate: la.-3l- 1�1 <br /> Phone: �a-9�.5-1543s� Alternate Phone: 611.-Sn%� �147�f <br />