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f f FOR CnT USE ONLY <br /> City of Orono Date Received: Permit# <br /> P.O.Box <br /> 2750 Kelley Parkway E]In-HouseSAC Determination Form Completed <br /> i•'� Crystal Bay,MN 55323 <br /> (952)249-4600/Fax(952)249-4616 Approved By(If Required}: <br /> CITY OF ORONO-SEWER& WATER/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 >epairs ❑ Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 3el <br /> Owner: ' tl r I" -L/ Mailing Address: / ;7- A A,,� <br /> City: 0 rV Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: r <br /> Contractor: �+' S Contact Person: ( 1 <br /> / - <br /> 49 <br /> Address: y��D i�GLt�vth� State License #. Z �� <br /> City: &IU at' t Zip: Expiration Date: 12 <br /> Phone: ��l" Zl�^ ��l`� Alternate Phone: <br />