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� <br /> � <br /> FOR CITY USE ONLY <br /> �,�` City of Orono Date Received: Permit# <br /> � `v P.O.Box 66 <br /> ���; � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> � �'���' ,� Crystal 13ay,MN 55323 <br /> � � � <br /> `��'E o` (952)249-4600 Approved By(If Required): <br /> 1,,rit?;�y <br /> �Psxo <br /> CITY OF ORONO —SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits inay require approval by the Building Official and/or Public Works Department*) <br /> (A1 I PFIiMITS Nlav he subiect to further review and mav not be issued when the application is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pennits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Perniit cards will <br /> be sent by retuin 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 conh-actors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility shib as-built locations. <br /> DO NOT EXCAVATE IN ANY STRF.:ET AND DO NOT TAP ANY MAIN without express <br /> approval of the Public Works Department. Issuance of a perniit 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 Apply) <br /> ❑ Residential(May Require Approval) ❑ Conunercial(Approval Required) Q <br /> �}._/ <br /> ❑ New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect �i ,r <br /> V t,�t <br /> J (Y\J <br /> Job Site/ Owner Information: ��� `\ <br /> -, _ \ � <br /> , ,,_ -� ;-� i ,k �+— t.. � I ( �- � <br /> Site Address: � � ` ��� 1 ` � - `—� ,�(� <br /> ; , ,�1� ;� � � `.fi��lin Address: °� ��}� <br /> Owner: �� ., ` 1 � � �� � �' .�: _. � � g �� <br /> � � . <br /> " 1\ <br /> city: ��� � �� ��� zip: �N <br /> , -'--- � <br /> Home Phone: '�' �' ��� � �� � ��Alternate Phone: <br /> Contractor Information: <br /> ��� <br /> Contractor: Contact Person: 1�,� <br /> � <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br />