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;t .I• <br /> �'���� City of Orono Date Recei�ed: C��p��•��p�I7—�/ � <br /> ; P.O.Box 66 <br /> ; 2750 Ke(ky Parkway Q In-I-iousc SAC Decern�ination Form Comp}cted <br /> y� `,�-f Crystal Bay,MN 55323 ,�) <br /> ��A�S H o�-y, (952)249-4600/Fax(952)249-4616 Appvnved By(If Required); �� , (/U <br /> CITY OF ORONO-SEWER&WATER/GENERAL PERMIT <br /> (*Note:Some pecmits may require approvai by the Building O�cial and/or Public Works Departmen�s) <br /> (ALL PERMTIS- 11Iav be subiert+�t.�rrh*r r.v1�and mav eot hr iccnHl wh��fLo+nnli a t �� <br /> GEI�ERAi,INFORi�A'I'IOI� <br /> 1. You may apply for utility permits by maii or in person at�e City offices. <br /> 2. Maiied in applicstions are subject to the postage and handling fee shown below. Permit cards will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are�ot valid until.yon 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 contractors only. <br /> 6. Contact the Public Works Department(952-249-4600j for utility stub as-built locations. <br /> DO NOT EXCAVATE IlV ANY STREET AND DO NOT TAP ANY MAIN wit6out eapress <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+�our notice reqnired. <br /> TYi'E OF PER�'T <br /> Ch�ck All That A: i. <br /> ❑Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> �'New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connecrion For Future Hook-Up to Water <br /> Jo� Si�e/Uvvn�r In�'or�ation: <br /> Site Address: �f T�--�c..-�r� <br /> Owner: Mailing Address: <br /> Cit3'� '� ��'� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Iri�ormation: <br /> Contractor: •K�,_�k � 4�-• `� S�'-15 Contact Person: �,�,,�,,. <br /> Address: ���'�� 1 C. �� � State License#: �j�'����(�3 <br /> City: 1-�� �-i.�.y Zip:�3 Expiration Date: i 2� r� <br /> Phone: �S Z�j 3� �(3�� Aiternate Phone: � � Z C-(3 L/ 2 `t S—`j <br />