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� � <br /> A FOR CIT USE ONl,Y p�Z <br /> 't���+�/�� City of Orono Date Received• � Permit# �����Ol�� <br /> P.O.Box 66 <br /> - ` ' 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> � � , Crystal Bay,MN 55323 <br /> `�r�?'��t��� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> ���o <br /> CITY OF ORONO— SEWER & WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoolication 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. 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. Wark 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 Warks Departnent(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 wark 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 Approva]) ❑Commercial (Approval Required) <br /> / <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 /> �70 � � <br /> Site Address: � y� 7�CY � (,��0�� <br /> Owner: Mailing Address: <br /> City: �I�CUI�U Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> 'G,,C'.w�''e <br /> � <br /> Contractor: (�L`�EC��I�-!� ���'Contact Person: l J��W� C��� <br /> Address: �5d� G�r �� � State License #: <br /> City: �Uv�� Zip:��� Expiration Date: <br /> Phone: `� L-�7� y`�S`� <br /> � � Alternate Phone: <br />