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h <br /> FOR CITY USE ONLY <br /> / ��Vp� City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> 111\l 2750 Kelley Parkway 0 In-House SAC Determination Fonn Completed <br /> ,,y`, �-,i Crystal Bay,MN 55323 <br /> \'\,A�S�ic¢j (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 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) 0 Commercial(Approval Required) <br /> i„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: 8 7s-' /am htfG k <br /> Owner: Dia I✓tLy MMts Mailing Address: <br /> City: 6ieONO Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: AS,/y. 1 h /' • Contact Person: //?/ CLtidie,*t! <br /> Address: 25/4 �02-iz At- State License#: <br /> City: 7641'1)44,6 Zip: 33 Expiration Date: <br /> Phone: to$1 VFfO. /2X-S- Alternate Phone: C2! a. 94 V3%' <br />