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, ^ <br /> FO� TY S ONLY O� 7 ?, <br /> O40,�`O City Of OCOIIo Date Received;� ��rmit# ��' ���—� <br /> `r P.O.Box 66 <br /> q�-, 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> � � � r Crystal Bay,MN 55323 <br /> ����4�0� (952)249-4600 Approved By(If Required): <br /> a'BA08 <br /> CITY OF ORONO —SEWER & WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Warks Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the auplication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pernlits by mail or in person at the City of�ces. <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 APPIY) <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: �L� ��'�U���" �i��L���C;��=�� <br /> Owner: �'�. (��1Gt bVl,t���Y'1 Mailing Address: <br /> City: ���:Y�Z�' Zip: <br /> Home Phone: `17 � -7�`�`� Alternate Phone: <br /> Contractor Information: <br /> � � (( <br /> Contractar: �C� V� � U�`� �� � � :_�,yt�Contact Person: � ��t'Y���Yl��`'�� <br /> Address: ._'�i;� ��i��,�1�11���� ���- State License #: <br /> City: �-i.� 1--�.s���-� Zip:�'�'; �; Expiration Date: <br /> c <br /> Phone: �lts�- �7� ���E.��-� Alternate Phone: (�:(,,�- �G�-�(� � 1 � <br />