Laserfiche WebLink
� � � �5� <br /> F CITY SE ONLY 2c��] <br /> " 0 City of Orono Date Receive oZ7 OPermit#o2D/D ^ QcJ /� <br /> � ���� P.O.Box 66 <br /> O O",�:, Z�50 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> [ <br /> � ���`� �� Crystal Bay,MN 55333 <br /> �''-- <br /> �x .r.o`.' (952)249-4600 Approved By([f Required): <br /> :�y�StO�y�� <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may rcquire approval by the E3uilding Official and/orPublic Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the anulication is received) <br /> GENERAL INFORMATION <br /> l. 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. Perrnit 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 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(952-249-4600)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 befare it is covered. Call (952)249-4600,24+hour 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 /> f � /�� <br /> Site Address: ��7� S[�ci c�v �J��a� ���C�' <br /> Owner: � tev� �e� � Mailing Address: <br /> City: U��' � O Zip: <br /> Lii.J../'�� �e, \ <br /> Home Phone:t ' S 2) j 5 � � �e S Alternate Phone: <br /> Contractor Information: <br /> Contractor: ��`r� ��� ►'"i�����'� ContactPerson: ���In � <br /> Address: �1 `1 d 5 ��° �I " State License #: � �' � I � 7 ` l�� <br /> City: S���� ��-� Zip:55��� Expiration Date: /2 3/ o��� � <br /> Phone: ��95z> aya ''z`� � Alternate Phone: <br />