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h <br /> POR CITY USE ONLY <br /> /�4OJ�tO City of Orono Date Received: Pit Si <br /> / ; P.O.Box 66 <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> j1101111C" Crystal Bay,MN 55323�e4ALSH (952)249-4600/Fax(952)249-4616 Approved By(fRequired): <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 Rode issuci when the amileati, , 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 /> lyiResidential(May Require Approval) 0 Commercial(Approval Required) <br /> 11 New Connection 0 Additional Connection 0 Re-Connection 0 Repairs 0 Disconnect <br /> 0 Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 2$72 idiZs Iuek 7Z4i4 <br /> Owner: Dgv/o I/El - , i-AytJ Mailing Address: <br /> City: Zip: <br /> Home Phone: brDND Alternate Phone: <br /> Contractor Information: <br /> Contractor: A s,/ &640-441.441 1*' ., Contact Person: ih'' 4 2„v e. <br /> Address: 29,' A• State License#: <br /> City: 1/4,1ydLS Zip: C'3 3 Expiration Date: <br /> Phone: 6 S7 V80,/34- Alternate Phone: (o/ 9/9 y.1ys.- <br />