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FOR CITY USE ONLY <br /> c--0Afrt City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> .' !\ (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> •ci. <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 subiect 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 'epairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hoo -Up to Water <br /> Job Site/Owner Information: <br /> i)Site Address: 1 IN 1 ' itif ?rL <br /> Owner: !1& Mailing Address: '' tJi i 4 i/ T"/ <br /> City: Oroi t Zip: S & 3& 7 <br /> Home Phone: (Q/) a�7 c 3'O// Alternate Phone: <br /> Contractor Information: ((�� <br /> Contractor: 4ihr- Pedit— Contact Person: <br /> Address: It/53t W. State License#: <br /> City: fly,"*--- Zip: S /o Expiration Date: l `1)"" <br /> Phone: 7113-Q ete- q I Alternate Phone: <br />