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I � �, . <br /> � � <br /> FOR CITY USE ONLY <br /> � ,��� Clty Of OCOnO Date Received: ' Permit# <br /> P.O.Box 66 <br /> . �" � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �. <br /> � �y?�� Crystal Bay,MN 55323 <br /> ���.'�'��O�a� (952)249-4600 Approved By(If Required): <br /> �ggg0� . � � . � . <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- Vlav be subiect to further review and mav not be issued when the aonlication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pemuts by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut 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 pernut card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Fublic 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 pennit 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 Connection ❑Additional Connection �Re-Connection ❑Repairs ❑ Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: � S 7 d y'�r�' Sh`'� l,��- <br /> Owner: �% -h. Z��Y1` Mailing Address: ��I �O /�/'t'�"� �� Qr <br /> City: Oron � Zip: S��'C � <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: � lr r � Contact Person: F�k� �G��t�C <br /> Address: /�iS�/� �d�^r�.L-.c. , St�.t�Lic�nse#: jU SZ <br /> � ,,_ <br /> City: (�'vtd�-ti- Zip:5��3 Expiration Date: <br /> Phone: ���- ���4��/� Alternate Phone: �fZ ZBZ- 3ZlJ(i Jascj� <br /> Ul�jVaD�i. <br /> � <br /> � <br /> I , <br />