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08/13/13 05:43 OLSONCONSTRUCTION 9524485289 p.02 <br /> r f <br /> ��'������ <br /> ��� <br /> _ ��USE ONLY <br /> :-�����1/r;:' City of Orano i�te tt�oiv P�mit# D l - 7�j'� <br /> '� P.O.f3ox 66 <br /> 2750 Ke]le,y Parkwa,y ❑[n-I•Ior�se SAC T�etennina6on Fonn Cumplcted <br /> �� � ;� Crystal I3a,y,MN 55323 <br /> '',!X�i''\ � '. (952)249-4C00 Ap�xavod By(If Required); <br /> �r�t�,.� <br /> CITY OF ORONO--SEWER&WATER/GENERAL PERMIT <br /> (*Notc:Some pemiits may require approvai by thc�3uilding Oft"icial and/ar Public Wurks Uepartment') <br /> (A�_L��RMtf3- Mav be sabiect to further review and mav not bc iasaed when the s�olic�tioo is�rece,�ved) <br /> GENERAL 1N1�4RMATION <br /> 1. You may apply for utiliry permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown betow. 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 an the job site. <br /> 5. Utility connection permits may be issued to licensed cflntractors only. <br /> 6. Contact the Public Works Dcpartment(952-249-4600)for utitity stub as-built locations. <br /> DO NOT EXCAVATE 1N ANY STREET AND DO NOT TAP ANY MA1N without express <br /> Approval of the Pubiic Works Depariment. 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. Cali(952)249-4600,?fi+hour notice requir�ed, <br /> TYPE OF PERMTT <br /> Check All That I <br /> �Residential(May Require Approval) ❑Commercial(Approval Require�d) <br /> ❑New Connection ❑Additional Connection �Ra�Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Gonnection For Future Hook-Up to Water <br /> 3ob Site/Owner.Cnformation: <br /> Site Address: �'��,��) 1 v ���'�;Y'�" ��l"r it�,',. <br /> Owner:�rLt..) --�f"C��►-��, l l.�- Mailing Address: . �C��� ��1�;���'��1�'�_' �� <br /> City: ���/��7:1�'1 '� zip: ��.�.��G7�� <br /> Home Phone: Alternate Phone: <br /> Contractor Infarmation: <br /> Contractor: (��;�,�Y") �{ ►'1` 'C�l�,�"t.�J�/►j Contact Person: I�t;t''k'�..�.C`� �J�('(`} <br /> Address: lp"1 !� �(,li�X..� �� State License#: �����- �,��j�� ._�`„� (,�'� <br /> . r" �f' ' <br /> c <br /> City: �,,�� � Zip:rJ___._ xpiration Date: <br /> � ��...�_`� �'�D <br /> Phone: C�`�i�-����:�--�j 7�/ Alternate Phone: � �- ��- � <br />