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, <br /> �. �( _�� L�l_ i' ! ��_ � <br /> �=- �� � �' <br /> � FO CITY USE ONLY <br /> ,��� City of OCono Date Received: O Permit#�r�D�/ <br /> O M1 O P.O.Box 6G <br /> �,;,,,,, 2750 Kelley Parkway ❑In-House SAC Detemiination Form Completed <br /> � �j�°`?���:-`. Crystal Bay,MN 55323 � <br /> �i,�� � <br /> � �;��'�;ys o (952)249-4600 Approved By Qf Required): <br /> t.?�it.��,�. <br /> �r��o <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 and mav not be issued when the anplication 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 Deparmlent(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 pernut 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 Apply) <br /> �] Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connecrion ❑ Additional Connection ❑ Re-Connection ❑ Repairs � Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: � 1 �� nla f-`7�1. S/��,-� �rr V'f <br /> Owner: G l f n /�/E d�f��rn f���lailing Address: 7�'`� /�'(i h n e TC,��li� /`/r�;4 (m�,� <br /> City: �-�'��9 �-c� V'� Zip: L<<,� �.��� S}-35--� L��P <br /> Home Phone: r <br /> !S' � � �-t 7.S - lI�3 Alternate Phone: 6l� � �/E'� 7.��o � <br /> Contractor Information: �-�'"� � ��(,(/1 �1,1,U1/� <br /> Contractor: O W N{- � Contact Person: <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> bwn� o r� �L-o P w� s�e,�.a en � �.! n�1 An���` � s�o rT3 /4PPR'°�al <br /> ��� <br />