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' RECEIVED <br /> _ _ <br /> JUN 0 5 2017 I�'OR CI"1'Y USE ONLY <br /> ._ o _, <br /> � �! �' City of Orono Date Received: Permit# <br /> � ''.o.�°"6� CITY OF ORON <br /> � 2750 Kelley Parkway In-House SAC DeterminationFonn Completed <br /> �, � � Crystal Bay,MN 55323 <br /> �'��,r����� � (952)249-4600/Pax(952)249-4616 Approved By Qf Required): <br /> . hrsiiu <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some pennits may requirc approval by lhe I3uilding Official and/or Public Works Department*) <br /> (ALI.PERMITS- Mav be subiect to further review and mav not be issucd when the apnlication 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 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 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 rec�uirements. <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 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: �.3 �{D _S�rt (�wc 'Jfr(i( d(iA✓'rt , �r� -S.S3 Y/-�i�oG <br /> Owner: �-1vY�n OS���iva✓� MailingAddress: ��o �,�,rc���e �r�ve <br /> City: {�avarr� Zip: SS39/ - ��� <br /> ---. <br /> Home Phone: G 1,?-36�— �/63 Alternate Phone: <br /> Contractor Information: <br /> Contractor: ln�rrs�,,�t �..-,a,4� L L C- Contact Person: �+�''� �a�r}Sr,r� <br /> Address: �C�� 3ox /0�8 State License #: �m d��9 7� <br /> City: �i�rs��e,�� Zip:S�S Expiration Date: ���31�/S� <br /> Phone: G��/' o?yk� 7�l�S Alternate Phone: �'S/- 7`s- o7Gs <br />