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r <br /> r � <br /> C1TY[l�T ONLY <br /> �-�NO� City of Orono D�LeRocei�ul: �P«�iclf _�l� <br /> P.O.Box 66 <br /> 2750 Keiky Parkway �In-Honse�AC Determination Fo�m Completed <br /> sR ,� Crystal Bay,MN 55323 <br /> �,� (952)249-4600/Fax(952)249-4616 APpmoved By(1flteqUf*+ed)c <br /> t1xESH�4- . . . . . � ��;� <br /> CITY OF ORONO-SEWER&WATER/GENERAL PERMIT <br /> (•Note:Some permits may require apProval by the Building Officisl aad/or Pablic Works Departrnent') <br /> tALL PERMITS- Mav be snbieet to tarther review and mav not be i�aed when We andimBon is e�iv�l <br /> GfiI�tE�tAI,INFORMATIOl� <br /> 1. You may apply for utility permits by mail or in person at die 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 yoa receive a permit card. <br /> 4. Work must not begin unless�e 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(952-249-4600j for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN wit6out ezpress <br /> approval of the Public Works Department. Issuance of a permit dces not grant dus 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)249-46�,24+tiour notice required. <br /> ' TY�'�OF PERA�IT <br /> Check AIl Th,�.t A: , <br /> ❑Residenrial(May Require Approval) ❑Commercial(Approval Required) <br /> ❑New Connection ❑Addirional Connection ❑Re-Connection �Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Jofi Si�!Ovv�er Infor�ation: <br /> Site Address: � � � S S � K ��/ � v v C <br /> Owner: S c v��" �� ��v� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor I�orrnation: <br /> Contractor: � �'``"� ����vu��h Contact Person: �'"�r / �' `'"t Gi <br /> � <br /> Address: S�'�S � "vu� ��/�ou����te License#: ���s ��� <br /> ,-�u �.- � <br /> City: �/l�t �e � 5 �i Zip:� 3 5 Expiration Date: � Z - � �— �� <br /> Phone: (9� Z -C���5 ,35� Alterna.te Phone: <br />