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FOR CPTY USE ONLY <br /> //04��0 City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> 2750 Kelley Parl:way ❑In-House SAC Determination Form Completed <br /> � n��'�' ��' Crystal Bay,MN 55323 <br /> ' `a (952)249-4600 Approved By(If Required): <br /> ����Rp6 <br /> CITY OF ORONO— SEWER& WATER/GENERAL PERMIT <br /> ("Note:Some permits may require approval by the Building Official and/or Public Works Departrnent*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued w6en the aovlication 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. Utiliry 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)249-4600,2A+hour notice required. <br /> TYPE OF PERMIT <br /> Check All That A 1 <br /> �,Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑New Connection ❑Additional Connection ❑Re-Connection ❑Repairs �isconnect <br /> Job Site/Owner Information: <br /> Site Address: ��L�ca � ��� , <br /> ���� . <br /> '�-� ��,��'�Owner: ���t/�,�P�G1� `, �GIL�'Y�{� Mailing Address: I ��� ��'� �`�S� <br /> � City: � � �- C � � S��� <br /> Zip: <br /> Home Phone: Alternate Phone: <br /> �la - �a3P � ��� <br /> �Vv� �'�Y� <br /> Contractor Information: <br /> Contractor: ���U�C�� /l�i�,�//1� ,�x'Contact Person: �C7`'�Q��/� <br /> _� <br /> Address: `t��'� � /!��/'!�� State License#: '��3 r� <br /> City: ��� J� Zip:��5 Expiration Date: �� 3I d �' <br /> Phone: '�✓�J �U Alternate Phone: (�`� ���� �y�� <br /> ���� � �/ <br />