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� <br /> �.� <br /> FOR CITY USE ONLY <br /> ,�0� Clty Of OrOriO Date Received: Permit# <br /> � � P•O.Box 66 <br /> �ry � 27�0 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> ��" �T{ ��µ.o`� (9�2)2 9a46 ON 55323 Approved By(If Required): <br /> ��'��� � <br /> sexoa <br /> CITY OF ORONO—SEWER & WATER/GENERAL PERMIT <br /> (*\'ote:Some permits may require approval by the Building Ofticial and/or Public Worhs Department*) <br /> (ALL PERMITS- N[av be subiect to further review and mav not be issued when the anolication 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. Pernut cards will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are not valid until you receive a pernut card. <br /> 4. Work must not begin unless the pernut 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 locatious. <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 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 ly) <br /> �(Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> �].New Connection ❑Additional Coimection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> Job Site/Owner Information: <br /> Site Address: ��U �v��� ��� /]��� � <br /> Owner: �� , c_l , I�����f�' � � Mailing Address: <br /> City: Zip: <br /> Home Phone: Alten�ate Phone: <br /> Contractor Information: <br /> Contractor: �_�=5��" rl�' S � Contact Person: S�i�.✓� � lc� � <br /> � �� <br /> Address: �;`��� ��' � F � � State License #: 1 C��>c��`�Z�' <br /> City: (��'l���ti c� Zip:��� �Expiration Date: ��� - .��'c�� <br /> Phone: ���T'��`�) 7..�" yg L'C- Alternate Phone: ��l:? � 7�l�r 7?J <br />