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� <br /> __, F�R C�TY USE�KLY ,��� <br /> j' (?�` City of Orono Date Received' Permit# � " ��\ <br /> '��g `r``� P.O.E3ox 66 1�''Y� Gy <br /> ��; a�� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed �'� <br /> � ����- ��F Crystal Bay,MN 55323 � �� ��� �� <br /> ��`� �� �:��o�%v` (952)249-4600 Approved By(If Required): � , �.1�� <br /> �aqsow,% �U <br /> ___ � <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT C� � �� <br /> (*Note:Somc permits may require approval by the Building Official and/or Public Works Department*) � _� , � <br /> (AI,L PER�([TS- Mav be subiect to further review and mav not be issued when the aoplication is received) �V � <br /> �J�� •�. <br /> GENERAL INFORMATION ` `� �� �� <br /> l. You may apply for utility permits by mail or in person at the City offices. <br /> � C <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will � �`, <br /> be sent by return mail within 2 business days. , ��� p <br /> 3. Permits are not valid until you 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(952-249-4600)for utility stub as-built locations. <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 1 <br /> [�Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> [�New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site I Owner Information: <br /> Site Address: d� _`�t, C� � S (�� �, <br /> Owner: Mailing Address: <br /> City: l�i�f�r�0 Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: �t I� t ;�t'I�j�-� Contact Person: _,�,i� ��� �� I�l�Y'Vl <br /> S <br /> Address: IZZ'�f-�r�_ S�� 1J� State License#: �-r,�.L� J�.S I� ��] <br /> City: �.��t_�1Gt.e� Zip:,z�(�Expiration Date: ��31 ��j <br /> Phone: �1C3��i'�-ZZ3(�a AlternatePhone: �'7(,�3-2�(p��jki��1 <br />