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,Jul 261,6 01:10p Metro Earthworks 763-428-2212 p.1 <br /> ,,_.---.�,` �Q T�/LtSE ONLY /�_ "`�� <br /> � � Ci of Orono ��o�J������'.-- � <br /> % .$ �0 tY <br /> ' . 1 P.o.Box 56 <br /> � 2750 Kclley Pafica�ay ❑1n-Hrn�SAC Determinati�FomiCompleted <br /> ''� �'' Crystal Bay,MN 55323 <br /> ����{�`HD0.ti� (952)249-4600:Faa(952)249�616 AQPro�d$Y(�f��)� <br /> CITY�F ORONO—SEWER&WATER/GENERAL PERMIT <br /> (*Nac:somc p�s�mts mar rey,m�zppro.al br thc aw�aing of6ael and/or Public works Ue�t*} <br /> lAT.L PERxn7'5-Msn•be a�iect jq fivf.�er revie+v and mrv not be jRxned wlew tbe amlicstion is necdved} <br /> GErt�xr�r,�avFox�vr�,TTorr <br /> i. You may apply for utility permits by mail or in person at the City offices. <br /> 2. MaiZed in applications are subject to the postage and handling fee shown beiow. Permit cards will <br /> be sent by return mait within 2 business days. <br /> 3. Permits are not valid until yor�receive a permit card. <br /> 4. Work rnust not begin unless the permit card is available on the job site. . <br /> S. Utiiity connection permits may be issued to licensed contractors only. <br /> b. Contact t�e Public Works Department(952-249-460Q)for utility stub as-buitt locations. <br /> DO NOT EXCAVATE IN ANY.STREET AND DO NOT TAP ANY MAn+i wit�oat eipress <br /> appruvat of tLe Pnbltc Works Departmeat. Issuance af a penoait does not grant this approval, <br /> 7. All work must be done in accordance with State Code requiremenis. <br /> 8. All work must be inspected before it is covered. Call(952)249-A60q 24+6ear notfae reqoired. <br /> TYPE OF PERNIIT <br /> Check All That A I <br /> �esidential(May Require Approval) ❑Commercial(Appmval Require� <br /> Q New Connecfiion ❑Addidonal Connection �e-Connection ❑Repairs Disconnect <br /> ❑ Water AvaitabiGty Connection For Future Hook Up to Watcr /��,�,� ��S <br /> �.St-�f��.. �����' �ti.1�.�1.� <br /> Job 3ite/Owner Information: <br /> Site Address: Z�{_�;���q�,S %= <br /> Owner: Mailing Address: ya� �'��`� r� <br /> City: •J. ;c: . ' Zip: ��l L� <br /> �-, y+'+n <br /> Home Phone: �p/Z'�,�' "a"�� Altemate Plzone: <br /> Contractor Infomoation: <br /> Contractor. �•� �i.�rl�cc� Contact Person: P!�'' �f lG���-'� <br /> , f <br /> Address: %�%�zi �'t'•�z�«�'��taxe�.icense#: <br /> City: � / ��Zip:-��`'c•�'ExpirationDate: ��' —f <br /> Phvne: �/`� �f�`�/� Alternate Phone: <br />