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FOR CITY USE ONLY <br /> City of Orono Date Received: Permit# <br /> (-0:04?. <br /> , 0 P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> a E� Crystal Bay,MN 55323 <br /> vik loo (952)249-4600 Approved By(If Required): <br /> '414-,„a'0,4" <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 /> (XI Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ANew Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: 2 / 7 5 j G <br /> Mailing Address: 2/ 75- <br /> City: <br /> SCity: Zip: .5- 5-3 <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ("Contact Person: u G, <br /> Address: 7/z o(/� � �� State License #: / 5 2- 1 <br /> City: �AZip: 53 ?73xpiration Date: 6 <br /> Phone: IZ-�/ 9- /Z747/ Alternate Phone: ll /2 l g - /y 6 Z <br /> { <br />