Laserfiche WebLink
n <br /> �1� <br /> � ��� <br /> FOR CTCY USE ONLY <br /> O¢��O City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC Determinarion Form Completed <br /> � •''�'• � Crystal Bay,MN 55323 <br /> �, �! '� . A roved B f Re wred <br /> r•x�-.o � (952)249-4600 PP Y� 9 <br /> �r�oe� <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require appmval by the Building Of£icial and/o�Public Works Department") <br /> (ALL PERMITS Mav be subiect to further review and mav Aot be issued w6eo the anolicAdon 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 applicarions 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 permit card is available on the job site. <br /> 5. Utility connecrion 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+hour notice required. <br /> TYPE OF PERMIT <br /> Check All That A 1 <br /> �Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑New Connecrion ❑Additional Connection ❑Re-Connection ❑Repaus ,�Disconnect <br /> Job Site/Owner Information: <br /> Site Address: � E Q� � �' � �/� w`'� �� �`'� <br /> Owner: �<:ii./ 5���v`� // Mailing Address: �3�'8 /'�« � /�� h/ Ur•�t S; N:' <br /> �/1/r ll I'�et r �6 � �i � <br /> City: Zip: <br /> Home Phone: Alternate Phone: C't/�'� 3��'-���'`� � s�g <br /> Contractor Information: <br /> Contractor: I<<�� �t E"�������'-'7 Contact Person: � �"�"� �' r`� h <br /> Address: ���� �r" ry s,�I�•.�"`.r State License#: /Y%�f <br /> t/Y. � <br /> City: ���'� t'� � Zip:5 ry��Expiration Date: ./�/-'✓ <br /> � s_r 7 ��r ii <br /> Phone: 76�rs"- ��t� Phone: �� ,� ` � � s�"` � �`� 3 <br />