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Oct �,1 13 Q8:58a Westonka Mechanical 952-472-4961 p.2 <br /> 16/21/2013 CB:49 9t2241d4bib ursurlu <br /> rjQ� C USE ONLY /)/11.2_3 <br /> City of Orono OarcReceive&Li ereaita o.p/3 -- <br /> 5 <br /> P.Q Box 66 <br /> [r i 2750 Kelley ciu <br /> Parkway Q In-Mouse SAC Dminatiun Form Completer! <br /> \1, Crystal Boy.MN 55323 <br /> 'f (952)249-4600!Fax(952)249-46t6 Approved By(If Required)_ <br /> �rr5 Lcc•at i <br /> CITY OF ORONO-SEWER&WATER J GENERAL PERMIT <br /> (•Nnte:Sonic permits may require npproval by the Building Official andlor Public Works Department•) <br /> (A Lt_PF45)(tTS. May beadiest to further revlcw_nnd may not_beltsued when_thw_alleation Is ressivsrp <br /> GENERAL INFORMATION <br /> I. 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. Ali work must be inspected before it is covered. Call(952)249-4600,244-hour notice required. <br /> TYPE OF PERMIT <br /> (Check All That Apply) • <br /> 4,1 Residential(May Require Approval) ❑Commercial(Approval Required) <br /> New CennectionAdditional Connection K Re-Connection ❑Repairs C]Disconnect <br /> PI Water Availability Connection For Future Hook-Up to Water <br /> Job Site)Owner Information: <br /> Site Address: F-20® .4.701 dJ er,e/ I cL <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: j /�• <br /> Contractor: % l 5/ice Contact Person: <br /> I�9`1o <br /> C_.-tll( <br /> Address: bs 0 I CV, a /C <br /> State License #: <br /> City: Ch.44J 7ipq Expiration Date: <br /> Phone: 99 7.2 / c1 Alternate Phone: ((2--?of-Q 7'2 9 <br />