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r <br /> 4 <br /> FOR CITY USE ONLY <br /> d City of Orono Date Receive:FAO <br /> : Permit# <br /> P.O.Box 66 <br /> e © 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> w Crystal Bay,MN 55323 <br /> `,r.e (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 /> New Connection ❑Additional Connection ®Re-Connection [❑Repairs ❑ Disconnect <br /> Job Site/Owner Information: <br /> Site Address: 2 / 2 0 �� X42 <br /> Owner __ 1- Mailing Address: Z- 1 2 6:, ----..-e----7--------, 7 % <br /> City: Zip: <br /> Home Phone: C75—Z Lf 71 ?'f W Alternate Phone: <br /> Contractor Information: <br /> Contractor Z.-,- Contact Person: 1--</e' .1_,- -�-,- <br /> Address: 7/2 2 69 r--- State License #: / Z / <br /> City: / Zip:2 ��/1xpiration Date: / 2 3 / 0 7 <br /> Phone: 1‘..7-1---/ 7 7"j~o LI? Alternate Phone: // 2 cl / 7` /9 6 <br />