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� <br /> , FOR CITY USE ONLY <br /> ,4�� City of Orono Date Received: Pennit# <br /> P.O.Box 66 <br /> �_�,•,: � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> � ������,,�`_ � Crystal Bay,MN 55323 <br /> �"� �n�;}.�o (952)249-4600 Approved By(If Required): <br /> '!'Csaxoa <br /> CITY OF ORONO-SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the a�nlication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pernuts by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Peimit 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 pemut card is available on the job site. <br /> 5. Utility connection peimits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600) for utility stub as-built locarions. <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 Apply) <br /> Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑New Connection ❑Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> Job Site/Owner Information: <br /> Site Address: �.o C� �w�,�-1,� ,�t�� <br /> Owner: �� ��Cs v�v�,�'� Mailing Address: �n C� S we�� �/� <br /> City: d�v�o Zip: S .�3�► j <br /> Home Phone: �/�`3 �a'� y0O Alternate Phone: <br /> Contractor Information: <br /> Contractor: ./�r-i o�-r^ �GS��� Contact Person: ��.�h <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> ;; <br /> ;i <br /> ; Gr ,,. <br /> � � <br /> � � , ' � r <br /> � � � � ` � <br /> ' � ' � � : '�' <br /> i <br /> i i h: � � �� �i � �I <br /> � !; � ' � � i i.i 'ii�, <br /> � , . � � �: � <br /> f �€ � :� <br /> :,� r. � �; � � � �: ,'� � <br />