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FOR CITY USE ONLY <br /> �0 City of Orono Date Received: Permit# <br /> 0" O P.O.Box 66 <br /> 2750 Kelley Parkway E]In-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> s � $a (952)249-4600 Approved By(If Required): <br /> CITY OF ORONO–SEWER& WATER I GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- May be subject to further review and may not be issued when the application is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express <br /> approval of the Public Works Department. Issuance of a permit does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> TYPE OF PERMIT <br /> (Check All That Apply) <br /> ❑Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> New Connection ❑Additional Connection Re-Connection ❑ Repairs ❑Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: <br /> Owner: N,4,44,90­f- Mailing Address: <br /> City: 012d-10 Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: 6CJ<CliN e— CcW$:'.wcT--'Contact Person: E– <br /> Address: Sys S �=✓� �C �S State License#: <br /> City: /�/���f ' Zip:SExpiration Date: <br /> Phone: ��y-sr =5�6 Alternate Phone: <br />