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FOR CITY USE ONLY <br /> ��/�/ City of Orono Date Received: �_� /�JPermit# 7��c:- <br /> � P.o.Box 66 ��S �(p <br /> ^ � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �, Crystal Bay,MN 55323 <br /> ".`� ��� (952)249-4600/Faac(952)249-4616 Approved By(If Required): � <br /> `�i.�ir�- <br /> CITY OF ORONO-SEWER& WATER!GENERAL PERMiT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Deparhnent•) <br /> (AI,L PF.RMITS- Mav be subiect to further review and mav not be issued when the applicatlon ts received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail ar 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 pernut 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+bour notice required. <br /> TYPE OF PERMIT <br /> Check All That A 1 <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/Owner Information: <br /> Site Address: r��- �� �i�„���Jr (�`l� <br /> Owner: 5�_��.,-_:,�,�,;,�,��� �n� Mailing Address: �a.S M�r� s� S�.J <br /> City: M,:..��,�..��6•'�S zip: 5,y�� <br /> Home Phone: 6�c�•'���I-�1�a1� Alternate Phone: <br /> Contractor Information: <br /> Contractor: C -! a ��e-� ContactPerson: (�:\\ C���'� <br /> Address: �6y r�� ��.\ n�,.af State License#: �A- �7.�7.`� <br /> City: �,�,��(� �or� Zip;�� Expiration Date: \o�• 3�- ��o <br /> Phone: ��\�,-�O`�3-�C11`1, Alternate Phone: <br />