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FOR crrY ONLY <br /> City of Orono DateReceived:3 3o I$ Permit!toZOId GV 5P.O.Box 66 <br /> (-81.10A/), <br /> 2750 Kelley Parkway ❑In-DouseSAC Determination FormCompleteds\i Crystal Bay,MN 55323 <br /> \ � 1 S N (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 not be issued when the annlicatinn 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) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection ❑Re-Connection ❑ Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Infonnation: <br /> Site Address: 289r lood/)tee,- i . <br /> Owner: DAVM) JV ' ilAtit5t Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: 2s,/�I, gke,4t9ir,4 /NL. Contact Person: /1I.i 4 /,��... <br /> Address: 2,4 gytr/ /4k State License#: <br /> • <br /> City: 71-14.54-3A/Ls Zip:C:a33 Expiration Date: <br /> Phone: /e$? Wi" /3 Alternate Phone: 4,2 2/1, Y1 y5'� <br />