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FC312 CITI'I7SE QNLY <br /> � City of Orono �'DateRece�v�d: � ° l�errrrit#�� ' <br /> O�" '�O P•O.Box 66 ' <br /> a�. 2750 Kelley Parkway 0 In-HoUse SAC DeEsrtnit�atian Form Compieted <br /> � `� ' Crystal Bay,MN 55323 roved B If Re uired <br /> ����� � (952)249-4600 kPP Y f Q }�= <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Depaztment') <br /> (ALL PERMITS- Mav be subiect to furt6er review and mav not be issued when the aanlication is receivedl <br /> GENERAL �NFO ATrt}N <br /> 1. You may apply for utility permits 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 card. <br /> 4. Work must not begin unless the permit 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 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 requirements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> 'I'�'PE OF FERIW�I�' ' <br /> ��' �����Ch��k All Thati�1 ���1 � <br /> �Residential(May Require Approval) ❑Commercial(Approval Required) <br /> �1ew Connection ❑Additional Connection �Re-Connection �Repairs ❑Disconnect <br /> Job Site/Qwnez��fornaation; <br /> Site Address: ��i S� ��5�- ����u r Cl(Z � � <br /> IATT' LW ti.l� M�C: <br /> Owner: CLiSIZ�M STJ2lifGTLtf?��5 Mailing Address: /Gb/ /Z D!9/LS t`�/U�'!#/L�3UN� <br /> City: ��b"IUa Zip: lj1>XI�Z'�� �///�.� .S.Sc�GI� <br /> Home Phone: �9.5Z� L�7� -'�Y.�� Alternate Phone: ��D�Z j Z`'Ije ��d�y'�� <br /> Con#ractor Infb�ml�tion: ' <br /> Contractor: ��/US �'14V19 T1/� Contact Person: Sl�VL-= �l.�L�'15 <br /> Address: ,3`l7(� CD� /2Cl- Z/ State License#: �g�� <br /> City: ' Zip:553�0(> Expiration Date: _��Z��� <br /> Phone: �GIS Z 95S�//Z Alternate Phone: C G�z,L U�� �y3��. <br />