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A <br /> FO CITY SE ONLY <br /> 04a: <br /> °4-4 <br /> � City of Orono Date Received: S(/I�Permit# <br /> P.O.Box 66 <br /> '� —' 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> aj��> ,�'L Crystal Bay,MN 55323 <br /> �� yG (952)249-4600 Approved By(If Required): <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 subject 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 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 /> Arj New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: ./e0 �/eEs2 j�G7r' <br /> Owner: ,5I/>=- T,//saw✓ Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: A-4-‘''.,-- C -c7:`v✓'4 ontact Person: v� f-� iJ <br /> Address:25' 3 A is State License#: <br /> City: /i'7.1'/'- '''J Zip;5Y3J Expiration Date: <br /> Phone: -9-2-`5 "--a-,1:3-- 5a Alternate Phone: /.•7-,5-- //6i. <br />