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� <br /> . <br /> � <br /> � <br /> ' FOR CITY U�SE ONLY <br /> ,��,�` City of Orono Date Received: ��Permit# �Dq42 ' <br /> `r P.O.Box 66 <br /> ��:�..,,, O 27�0 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> p� �;'' F Crystal Bay,MN 55323 <br /> ��t�������,�.�o~ (952)249-4600 Approved By(If Required): <br /> '��sxo$ <br /> CITY OF ORONO— SEWER& WATER/ GENERAL PERMIT <br /> (*Notc:Some pennits tnay require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the annlication is received) <br /> GENER.AL INFORMATION <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. Pernut cards will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are not valid until you receive a pernut card. <br /> 4. Work must not begin unless the pernut card is available on the job site. <br /> 5. Utility connection perinits may be issued to licensed contractars only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locatious. <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 peimit does not grant this approval. <br /> 7. All work must be done in accordance with State Code requu�ements. <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: � � y S ��J�-( I D 1 M� I�prr1 I�i <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> oA�G C��.av�i �� �•�t- <br /> Contractor: i�A'-�d£. ('�e� �Nl�, ContactPerson: ��� ����� <br /> Address: f:�,���. � �� State License #: � 3 3 0 <br /> City: �r:��N��� Zip:��`�7P Expiration Date: <br /> Phone: �b 3 ���3 '��'p�- Alternate Phone: b ��'` � �'��"�7 3l0(� <br />