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FOR CITY USE ONLY <br /> ¢,0 City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> 0 � 0 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> 4. (952)249-4600 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 aaolication 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 /> S. 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-ConnectionRepairs ❑ Disconnect <br /> ElWater Availability Connection For Future HooAp to Water <br /> Job Site/Owner Information: <br /> Site Address: <br /> Owner: >�J �� /e-( Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone. <br /> Contractor Information: <br /> Contractor: ���� `� �T ���C'� Contact Person: <br /> Address 6 State License #: 5 / �7 <br /> City: (� I�TE Zip % Expiration Date: <br /> Phone: �C s T� � �� Z. Alternate Phone: -; - %% `l rz-y <br />