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f � <br /> ii CTI'Y U��ONLY <br /> ����` City of Orono �ace Recei�ed: Pumit# <br /> ; P.O.Box 66 <br /> ` 2750 Ketley Parkway ❑1n-House SAC Determinarion Form Completed <br /> y ,�-� Crystal Bay,MN 55323 <br /> `' � (952)249-4600/Fax(952)249-4616 Approved By(IfRequired): <br /> \ � <br /> �xESH�¢� . , - . . <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERMIT <br /> ('Noh:Some peamits may require approvai by the Building Official and/or Public Works Departrnent') <br /> (ALL PERMITS- Mav be subiect to(urther rcvfew and mav not be isaued when the anolication is rnxivedl <br /> GEI�1E�tAL INFORMATIOl�i <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 retutn 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 cazd 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 ezpress <br /> approval of the Public Works Department. Issuance of a permit dces 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+6our notice required. <br /> TYPE OF PER�VIIT <br /> Check All That A i . . <br /> (�Residential(May Require Approval) ❑Commercial(Approval Required) <br /> (�New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Ovvrier In�or�ation: <br /> Site Address: �'�� SA��GL ,�, <br /> Owner:�1'�d �J✓��f ���.5 Mailing Address: <br /> City: �'�� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: Q�./y ��n�'L !^'�• Contact Person: /�ik� �d��'�'�'�'L <br /> Address: 29/6 �%V�X�Oc��A'�� State License#: <br /> City: ,Z��S Zip:S's�33 Expiration Date: <br /> Phone: �i�� �,/,�£� Alternate Phone: �/�. 9�9 y3y�" <br />