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� <br /> . <br /> -�.� O C USE ONLY � �-~ <br /> ��-��O� City of Orono Date Receive�'� Perinit# D/7 `� ��`r <br /> �' •� P.O.Box 66 <br /> , � � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> ,�-�' Crystal Bay,MN 55323 <br /> �\�`\�t.i',�(�¢j� (952)249-4600/F�(952)249-4616 Approved By(If Required): <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approva(by the Building Official and/or Public Works Departrnent') <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued wheo t6e aoolication is received) <br /> GENERAL INFOR2vIATION <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 pemvt 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 Deparnnent(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 accardance 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 PERIvIIT <br /> Check All That A pi <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 /> Site Address: `1 �C7 ��.v��.i;,,���� ��D <br /> Owner: V f���I,�,�(� ��w Mailing Address: �7 St-�� �,l�c,r�`�.��1 �p <br /> City: �:`�:nn Zip: ��3�\ <br /> -r--- <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: GoQP`� 5�..���w �,J�.al Q� Contact Person: (�`.�.\ cno�: !� <br /> Address: ��� (��'.� ,�tC,�'f State License#: S7�3 �y- M� <br /> City: 1_1����� Zip:S� � Expiration Date: 1�- _��- �� <br /> Phone: �\d. • Sn4�-���1`1 Alternate Phone: <br />