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I <br /> FUrmR CITY USE ONLY <br /> (-81L04,-,-;, City of Orono Date Received: Peii# <br /> P.O.Box 66 <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> (•.-y ,t)111(L"-J Crystal Bay,MN 55323°\�ssHo¢j G (952)249-4600/Fax(952)249-4616 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 subiect to further review and may notbe issued wbeo the aoolication 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) 0 Commercial(Approval Required) <br /> 5.New Connection ❑Additional Connection ❑Re-Connection 0 Repairs ❑Disconnect <br /> 0 Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: k IS q vt. '\ \.u C �- T C <br /> Owner: K2,\.\/ E-‘o-e. n r\ Mailing Address: \.4 k U (.,CQYoiec Rb <br /> City: t✓A.;r.n e_L3n1e,„ Zip: g S- V{S <br /> Home Phone: Ga.- 10- 5a\c\ Alternate Phone: <br /> Contractor Information: <br /> Contractor: cov, 6e,,,,izr 4, Malec Contact Person: e;: \ r occr\ <br /> Address: ?G9 avocA ,pry State License#: S .) 3 a`'1 - M K <br /> City: V.) 4(%cxY r\ Zip:S 3igg Expiration Date: kA -3` - V/ <br /> Phone: l a.- c 8-'t 9 79 Alternate Phone: <br />