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.�: . <br /> D��� <br /> %` -�- FOR CITY USE ONLY <br /> � ��/�/O , Clty of 01'Ono Da[e Received: Permit# <br /> � P.O.Box 66 <br /> ` ' y 27�0 Kelley Parkway ❑[n-House SAC Determination Form Completed <br /> �, � . , Crystal Bay,MN 55323 <br /> y°.' �-'II (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> �.'�K}y�.i���tF�. <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 PERNIITS- Mav be subiect to further review and mav not be issued when the aaalication is received) <br /> GENERAL INFORMATION <br /> l. 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 ly) <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> New Connection ❑ Additional Connection Re-Connection ❑ Repairs ❑ Disconnect <br /> ❑ Water Availability Conn ction For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: __3Q�� �. �J`�d�2� �2. <br /> Owner:__S�/YL�✓� ,�LD�S. Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> I , /� <br /> Contractor: ,�5,/yl_ v�Jl'Gff1/A�'N�v Contact Person: �.� �ad�i�ra/` <br /> Address: 29/�s ���'F.+z�is�/7!� � State License #: <br /> City: ! � �S Zip:� Expiration Date: <br /> Phone: ��'� �d� /3� Alternate Phone: 1�I� 9i9� y��� <br />