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i <br /> C U'lE ONLY <br /> �0 �\ City of Orono Date Received =6.PematP.519 7 <br /> P.O.Box 66 <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> \ k (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> 'rSHU¢� <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 subiect to further review and may not be issued when the anuli 9Kon 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(952-2494600)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)2494600,24+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 10 Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: '� <br /> Owner: N\t t N- O V1Ac S Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ` Qe_ S W F Contact Person: �e t 404&AJ< <br /> Address: X201 ��. -+��' State License#: lel Ci'7 <br /> City: APW C n-- Zip:SS3q(Expiration Date: <br /> Phone: '� 8702 Alternate Phone: 770-2-a1-8 702, <br />