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1 _ <br /> FOR CITY USE ONLY <br /> ,��A, City of Orono Date Received: Permit# <br /> `w P.O.Box 66 <br /> ��:;.,.,,,,, � 27�0 Kelley Parkway ❑Tn-House SAC Determination Form Completed <br /> ��`` ��!' Crystal Bay,MN 55323 <br /> a <br /> ��^ �T����;;�,4.�0` (952)249-4600 Approved By(If Required): <br /> ��sxoe <br /> CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some pennits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- b�iav be subiect to further review and may not be issued when the�unlication is received) <br /> GENERAL 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. Permit cards will <br /> be sent by retum 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 pemut 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 peimit 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 /> esidential(May Require Approval) ❑ Conunercial(Approval Required) <br /> [�1ew Connection ❑Additional Coimection ❑Re-Connection ❑ Repairs ❑ Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: �{/ [.D � � �t'/ ,�j/lJ � �� 2 <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: A1tenlate Phone: <br /> Contractor Information: <br /> Contractar. �__���� ��� Contact Person: <br /> � <br /> Address: � �s` �it�l�� State License#: �� `li � <br /> � <br /> '//� � <br /> City: �� Zip:�s�7L�fcpiration Date: � �— �j � v S <br /> Phone: G� � �y ��7 Alternate Phone: , � 7j y 7 � �,r 7 �L <br />