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f � � <br /> FOR CITY USE ONLY. <br /> 0,��,�`O City of Orono Date Received: Permit# <br /> `r P.O.Box 66 <br /> �\ 2750 Kelley Parkway ❑In-House SAC Determination Form Compieted <br /> � � � f' Crystal Bay,MN 55323 <br /> ' ���'� ��''�G� (952)249-4600 Approved By(If Required): <br /> �y�go$ <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 /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aualication 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 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 Deparhnent(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 pernut 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 /> ❑ Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection Re-Connection ❑ Repairs ❑ Disconnect <br /> ❑ Water Availability Con ection For Future Hook-Up to Water <br /> Job Site/Dwner Information: <br /> i <br /> Site Address: �--� ��� ���;-�� L��(� et.�.�� . <br /> Owner:�f'�J� ���-t"�. Mailing Address: r,�� <S�;C.riC2,�. c� � <br /> City: ���` Zip: a--�j� Z <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> � ,.� <br /> Contractor: �/� � �`'L ���% Contact Person: � L'�/'.�-// <br /> Gf���S'S F�i'!��'G-9:/�.eS' t�.�/� <br /> Address: �G°'�s�OX ��� ` State License#: Z��zr —���jf <br /> City: S �Zip: Expiration Date: ��' <br /> Phone: ����� �� Alternate Phone: ��6� — �y/S' <br />