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w <br /> . <br /> - FOR CITY USE ONLY <br /> �/ �O\,� City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> ' 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> CCrystal Bay,MN 55323 <br /> c` (952)249-4600 Approved By(If Required): <br /> 'kcs How <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 /> El Residential(May Require Approval) El Commercial(Approval Required) <br /> El New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 10 'l.0" &a (i-vvI.",,ir L-./1) <br /> Owner: Qj&\S cca(�p Q - K Mailing Address: $�-Il�o 5 y(c cy. c-,( <br /> City: I`€ Qf;c__IA. Zip: 2.\-1 p\ <br /> Home Phone: Alternate Phone: 0.4O,-;(-i7 --1‘443-S-• <br /> Contractor Information: <br /> Contractor: Ln ,r.' r..x.� S- �,..)jJ .Q(Contact Person: (�,` ,� GG P, <br /> � <br /> Address: `UN a. s,--- ex,Nil State License#: S ) . 0), \ -/v) <br /> City: t <br /> wi .\ Zip:.: Expiration Date: qs-- <br /> Phone: ()a-O8- '.l 7-\ Alternate Phone: <br />