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T4: 9522494616 From: Dispatch 12-08-17 3:20pm p. 4 of 4 <br /> FOR rl�pt isE any <br /> *lic.101VCity of Orono Date Received: ii Permit# pt1-01(�f�}. <br /> P.O.Box 66 j <br /> liski 2750 Kelley Parkway []!n House SAC Detetttunafian F rtn Completed <br /> Crystal Bay,.MN 55323 <br /> r 4.-\,,,....".' (952)249-46001 Fax(952)249-4616 Approved ley tlfRequired): <br /> ,li . <br /> CITY OF ORONO-SEWER er WATER f GENERAL PERMIT <br /> (*Note:Some permits may requite approval by the Building Official and/or Public Works Oepartrnent C) <br /> (ALL PERMITS-May be subiect to further review and may not be issued when the application is received) <br /> GENERA=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 ANI)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) 0 Commercial(Approval Required) <br /> New Connection 0 Additional Connection 0 Re-Connection <br /> '®.Repairs 0 Disconnect <br /> ❑ Water Availability Connection For,Future Hook-Up to Water <br /> Job Site/Owner Information: J <br /> Site Address: 20.0t (,),e. ..e-' kb 114 _ rj <br /> 41 <br /> Owner: . v5tl,.t Z.?IA L.r-.& Mailing Address: <br /> City: ldrotn,p Zip: 5-5-'3? 7 <br /> Home Phone: 41,7--^ 7 11_ y 7,22 Alternate Phone: <br /> Contractor Information:' <br /> Contractor: /fir Roo-1-1,- avwt17:ie Contact Person: <br /> Address: . 57$5"` , g:./c..- g4- I(tate License#: PC-46 y 7 3 3 <br /> City: F.'ci if, . Zip:55.—Y02/Expiration Date: <br /> a - 3/- r7 <br /> Phone: 76 3 S`S(--0 c5-5" Alternate Phone: <br />