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FOR CITY USE ONLY <br /> � Clty Of OrOnO Date Received: Permit# : <br /> Og �O P.O.Box 66 ' <br /> 2750 Kelley Parkway ❑In-Hou"se SAC Determination Form Completed <br /> ,P� Crystal Bay,MN 55323 � � <br /> ��_ ° ' �G�� (952)249-4600 Approved By(If Required): <br /> �sao$ <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERMIT <br /> (*Note:Some pertnits may require approval by the Building Offtcial and/or Public Works Qepartment") <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the anolication is received) <br /> GENERAL INFORiVIATION , <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. Pemut cards will <br /> be sent by retum 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 con�actors 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 requirernents. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> , .TYPE OF FERM�'T <br /> (Check Al1 That A 'ply) <br /> �f�esidential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑New Connection ❑Addirional Connecrion ❑Re-Connection ❑Repairs �Disconnect <br /> Job Site/Owner Information: ' <br /> Site Address: �'I ��� .��' h � O� �� � <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: '�'���o��e Sl� Contact Person: ��(,�.�, �I� f�1 <br /> Address: ��( �• �N • �5� State License#: ��d�/!�� <br /> City: �� `�`� Zip: �36'�Expiration Date: 2 .� � <br /> Phone: �� I �7a'�`�� Alternate Phone: ��� � l c7 �7 / <br />