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FOR CITY USE ONLY <br /> �4 --,;;;; City of Orono Date Received: Permit# <br /> `r P.O.Box 66 <br /> " 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> t Crystal Bay,MN 55323 <br /> N a~ (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 /> 0 New Connection ❑Additional Connection ❑ Re-Connection ❑ Repairs ❑Disconnect <br /> Job Site/Owner Information: <br /> Site Address: 2- Z �S�,�i✓��%� f �� ����' — <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: � 4 75T it Alternate Phone: <br /> Contractor Information: <br /> Contractorr , Contact Person: <br /> Address: 7/2 .-Z"" State License #: ( 9 z <br /> City: %( J�o Zip:[fl/JExpiration Date: <br /> Phone: lo 4'77 c471/- Alternate Phone: P2 9/ `Lf 4-( <br />