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Y <br /> / � <br /> ....�C V0��1�L1 <br /> �D�Q�� City of Orono Date Recei�ed: ';� Per�iz# 0�17-0 3 <br /> ; P.O.Box 66 <br /> j 2750 Kelky ParkwaY ❑In-I�o�sc SAC Decerminption Form Compleud <br /> s ,�'J Crystal BsY,MN 55323 <br /> ��'�A[sH�4'�G, �952)249-4600/Fax(952)249-4616 Approved BY(If Required�: <br /> CITY OF ORONO–SEWER&WATER/GENERAL pERNIIT <br /> (*Note:Some pumits may require approval by the Building Official and/or Public Works Departmqrt+) <br /> (ALL PERMTIS. Mav be aobierr t�n�.�th��.•.�t�aod mav eot iecnrtl rh�n f6�'nnliwaH t �� <br /> GEI�TE�tAi.,INFORMATIOI� <br /> 1. You may apply for util'rty 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 yon 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�952-249-4600j for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without ezpress <br /> approval of the Pubtic 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 /> TYi'E O�PER�T <br /> Check All That A <br /> ❑Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection ❑Re-Connection ❑Repairs �i�isconnect <br /> ❑ Water Availability Connecrion For Future Hook-Up to Water <br /> Jo� Si��/Ovvt�er In�m�afion: <br /> � � � � <br /> � G <br /> Site Address: � � � -> t`-� , ` ,- �--t,'���-�; � � x�.._� � <br /> Owner: Mailing Address: <br /> City: ' ` c :,.-. c, ZIP. �_- � -� �� � <br /> �_ , <br /> —� <br /> Home Phone: Alternate Phone: <br /> Contrac�o.r Information: <br /> --� �� i . <br /> �::x> ',� � � ` (ti <br /> Contractor: ; -� .- � , � Y f Contact Person: � �" �-� �� ..�,, �.��.. <br /> Address: � ��� � � � �--�� 3 State License#: ��; (-,'( Y t/ �3 <br /> Ciiy: ����'��-� > Zip;}S��i � Expiration Date: I � � � `� <br /> Phone: �1 � Z `� 3�' y � �3 Alternate Phone: �' � � z� 3 `f 2 `i S ( <br />