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RECEIVED <br /> DEC 2 6Z017 <br /> FOR CITY USE ONLY <br /> City of Orono CITY OF ORONO Date Received: Permit tt0/7_Q1(p 4 <br /> P.O.Box <br /> r <br /> 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> A� Crystal Bay,MN 55323 <br /> a > <br /> s <br /> (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> �kF5 0 <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 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 pen-nits 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: 0n ILa AU Gam. I2ct_ <br /> 'DOX Owner: O (/I 0�f/�_ Mailing Address: 0 U �bl LrLQ.WQ��G� <br /> City: by-mo Zip: SS 3 SZ�, <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: s SSM/ 601 Contact Person: 1 Y LZ W1,3 ka-P <br /> � t <br /> Address: t l l S9 S-+'A S/SIE State License#: <br /> City: P&M-y Zip: Expiration Date: <br /> Phone: 7✓Q.3 y-ZQ Cl 030 Alternate Phone: to (Z Ne(e lQaq I <br />