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FOR CITY USE ONLY <br /> ��(��,`�.\ City Of OI'ono Date Received: Pennit# <br /> P.O.Box 66 <br /> �O � O Z750 Kelfey Parkway ❑In-House SAC Determination Form Completed <br /> �� }�'14,`. � Crystal Bay,MN 5�323 <br /> �'�',��ny��o` (952)249-4600 Approved By(If Required): <br /> \,��p4 <br /> C�TY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Notc:Some permits may require approval by the Building OfYicial and/or Public Works Department*) <br /> (ALL PERM1�ITS- Mav be subiect to further review and mav not be issued whe�the�nnlication is reccived) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility perinits 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 c1rd. <br /> 4. Work must not begin unless the pennit card is available on the job site. <br /> 5. Utifity 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 1N ANY STREET AND DO NOT TAP ANY MAIN without express <br /> approval of the Public�Vorks 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 /> TYPC OF PERMIT <br /> Check All That A 1 <br /> �Residential May Require Approval) � Commercial (Approval Required) <br /> S'e�.�we. �.vlf�' <br /> �New Connectiot� ❑Additional Connection o ection �Repair �Disconnect <br /> Job Sitel Owner Information: <br /> Site Address: ,�l�s /Y. s ,� ,��/� <br /> Owner: Mailing Address: <br /> City: Zip: ' <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: /L%e� �7�� Contact Person: ��� �/�� <br /> Address: /l 5 State License #: �'�O`/oZ <br /> City: ou��/ Zip:.S338�j Expiration Date: /��.�/�D T <br /> Phone: ��� 3�3 �l f�'c� Alternate Phone: <br />