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�_---.'�� FOR CTTY USE ONLY <br /> ,��� � City of Orono Dace Received: p�;t# <br /> ' � �'• P.O.Box 66 <br /> ! ; <br /> ; 2750 Kelley Parkway ❑In-House SAC Determinaqon Form Completed <br /> �y� �� Crystal Bay,MN 55323 <br /> \\���s������ (952)249-4600/Fax(952)249-4616 Approved By(IfRequired): <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERNIIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Departrnent`) <br /> (ALL PERMII'S- Mav be subiect to further review and mav not be issued when the anolicatlon is receivedl <br /> GENERAL INFORA�ATION <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. Pernvt 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 availabie on the job site. <br /> 5. Urility 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 PERM�T <br /> (Check All That A 1 <br /> �esidential(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 information: <br /> Site Address: � Z Z� (� �i i'� / J�-� <br /> Owner: l T�� t����! i�� Mailing Address: S�"'` `�C.- <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Inforrnation: � � <br /> Ly / <br /> Contractor: �u�L�c ��c��U u�'`��ontact Person: L��� vr Gvt <br /> � <br /> Address: �v�� �o - 1Z�_ � Q State License#: �� �y � �1 L� <br /> City: �1�u u�-�'%�� Zip:-5� j�Expiration Date: � Z — 3 �— l 5� <br /> Phone: ��Z � ���—S�S`�S �ternate Phone: <br />