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FOR CITY USE ONLY <br /> 04)--. ) City of Orono Date Received: Permit# <br /> //I�' P.O.Box 66 <br /> o r 2750 Kelley Parkway ❑hi-House SAC Determination Form Completed <br /> 1 Crystal Bay,MN 55323 <br /> 4° (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 /> dSite Address: / ln� i I lc�o �` <br /> Owner: (0 yip'? , _ Mailing Address: <br /> City: (< Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: Vk-- "S(O0 GSC VLA) Contact Person: R,,'i h C LG/v, <br /> Address: .7/ CO. d. ( s- State License#: 1 Trp (71/ 1-1 <br /> City: !/1/1¢Lnvt Zip:S33eExpiration Date: ( -_?/--os <br /> Phone: (95—.. ) C17-2- q Alternate Phone: (--- Q 7V/- 7? <br />