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� <br /> • FOR CITY USE ONLY <br /> ,��� CitV of OrOnO Date Received: ` - %-C:�Permit# - 1`�/S� <br /> P.O.Box 66 <br /> ���..,,, O 27�0 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �y'� �;�`� Crystal Bay,MN 55323 <br /> �e�����,�,a�.�o`� (9�2)249-4600 Approved By(If Required): <br /> sexo$ <br /> CITY OF ORONO —SEWER & WATER/ GENERAL PERMIT <br /> (*;Vote:Some pennits may require approval by the Building Official and/or Public Worhs Department*) <br /> (ALL PFRMITS- Mav be subiect to further revie�v and ma�•not be issued when the�npnlicution is reccived) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pernuts 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 wiYhin 2 business days. <br /> 3. Permits are not valid until you receive a pernut card. <br /> 4. Work must not begin uilless 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 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 espress <br /> approval of the Public Works Department. Issuance of a perinit 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 /> ,E]Residential(May Require Approval) ❑ Conunercial(Approval Required) <br /> ❑ New Connection ❑Additional Coimection ❑Re-Connection ❑ Repaus ❑ Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: �; 7y j �-i� • i<<���f ��t <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: �c�'�`V��v y sli,,.i Contact Person: ,�('��c-•'i C%'�'I <br /> Address: /�.�O I Cc`�. ��• (`j State License #: 'c�d�1��'�i <br /> City: , �/�/���✓1� Zip:�'S�� Expiration Date: (��%�GS� <br /> Phone: �7�� y�T S�1 Altenlate Phone: � /� � ?���- �l ��� <br />