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1111812014 14:58 FinalGrade f AX)952 492 5101 P.0021003 <br /> h <br /> FOR CITY USE ONLY <br /> *'aaVWA <br /> City of Orono DOW Rectived Pe mit# <br /> P.O.Box 66 <br /> 2750 Kelley Parkway L]In House SAC Determination Fo m Completed <br /> BalaY, <br /> (952)244Fax 52 249.4616 Approw d By� � <br /> Rcq ); <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERMIT <br /> (*Nat'-.'some permits rosy require approval by the Building Official and/or Public Works Dcpartrrcnt*) <br /> (ALL ERMITS-May he subleet to further review and unav not be tuned when the agplkatton is received) <br /> GENERAL INFORMATION 71 <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 /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: . <br /> Site Address: 40 72) 70/l// .4 /?QAZ <br /> Cel/9r4/,-s ,,t"� <br /> Owner: �A a ( (of (oder `5 Mailing Address: I?A:14 ogSYom <br /> Q!A <br /> City: Zip: <br /> Dome Phone: Alternate Phone: G/K- 3,3r3 &4) <br /> Contractor Information: <br /> Contractor: YAC e_�N6Contact Person: <br /> Address: �'S Vl e U> F ��i�Q. State License#: !g02. <br /> City: Zip: Expiration Date: <br /> Phone: 9? 4Z Alternate Phone: <br />