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Jul 26 16(11:10p Metro Earthworks 763-428-2212 p.1 <br /> _,----..,, �t USE ONLY p <br /> ;'$-��l��, City of Orono nare R«xivcq// Pea�rit i��1 �a <br /> � P.o.Sox 66 — <br /> �r ; 2750 Kclley Parku•ay ❑In-Rouse SAC Determination Fomt Completed <br /> s��, .'% Crysta�BaY,MN 55323 _ <br /> �`•�C(` �� (952)249-4600;Faa(952)249-4616 Appmved$y(IERequired): <br /> \.�4�cyof./ <br /> CITY OF ORONU—SEWER& 'WATER/GENERAL PERIVIIT <br /> (*Note:Somc pa�s may cr.quirc apptmal by the Bw7ding Officis2 and/or Public Works Depattmcnt') <br /> iAiT p�]t�YYTS_Mav be anbi_ect to further revlen��1 m�v not br jtisaed w�en t��n_oliestion j��redl <br /> GENERAL 1NFORMATI4N <br /> i. You may apply for utility permits by mail or ia person at the City offices. <br /> 2. Mailed in applicatioas are subject to the postage and handlmg fee sl�own below. Permit cards will <br /> be sent by return cnail within 2 business days. <br /> 3. Permits are aot vaiid undl you receive a}�ermit card. <br /> 4. Wark must nat begin ualess the permit card is available on the job site. <br /> 5. Utility conuection peimits may be issued to licensed contractocs only. <br /> 6. Contact the Public Works Department(952-249-460(?)for udlity stub as-bui�t loeatior�s. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN wit�oat ezpress <br /> approval of the Pnblk Works Departmeat. Issuance o£a permit does not grant this aQproval. <br /> 7. AI[work must be done in accordance with State Code requirements. <br /> 8. AIl wurk must be inspected before it is covered. Cell(95Z)249-4600,24+hour noti�reqaired. <br /> TYPB OF PERMIT <br /> Check All That A I <br /> �dendal(May Require Approval) ❑Commercial(Approva!Requued� <br /> Q New Connection ❑Additional Connecrion �e-Connection ❑Repaus Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Waroer ' <br /> -�S't=�;�� ��! �c' ��''�`�� "�S <br /> Job Site/Owner Information: � `�`�� <br /> Site Address: ZC�� �.�.�,,�'j %-_ <br /> Owner. ; Mailing Address: �a�U c�'i'��f 1F/ <br /> City: ✓. :c ' Zip: �l�C�% <br /> �4-� �� <br /> Home Phone: „fp1 Z '��'�G� Altemate Pltone: <br /> Contractor Information: <br /> Contractor: ��� ��tl�c� Contact Person: Pl�'' �f lL��•-� <br /> Address: /�%✓i� F�`f'•�'�'��'��State�.icense#: � ,f <br /> City: < �< ��Zip:-5����ExpirationDate: ��� —� <br /> Phone: � ,��"��`��.5/� Alternate Phone: <br />