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A <br /> 0R CMV USE ONLY <br /> O¢OHO City of OronoDate�ecel �`Permit# <br /> P.O.Box 66 —� <br /> 2750 Kelley Parkway © ►96u5e'St c Diit rmination Form Completed <br /> Crystal Bay,MN 55323 <br /> (952)249-4600 Aprhved B (Tftegpued) <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 application is received) <br /> GENERALOIA'lTfi <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 /> Ji <br /> 3A 1 ). <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 /> Todte f` WTD Qrilllf a <br /> Site Address llt� <br /> Owner: Mailing Address: <br /> City: Orono Zip: <br /> Home Phone: Alternate Phone: <br /> Con pr Ir�'c�rna tic ; <br /> Contractor: ..e Contact Person: It'7J-65C_ L Al� (AM <br /> Address: �-70 State License#: 6 ! 15� "FAI <br /> City: 5�, V ( Zip: Expiration Date: <br /> Phone: �j� - 6q3- `549.- Alternate Phone: <br />