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- FOR crrY usE o:vt.r <br /> -,��Z����� City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> �� � 2750 Ketley Pazkway ❑In-House SAC Deterniinauou Form Completed <br /> i , �- Crystal Bay,MN 55323 <br /> �'f,`,�_�t�'� ,•��� (952)249-4600/Fax(952)249-�i616 Approved By(if Required')� <br /> � <br /> CiTY OF ORONO— SEWER&WATER/GENERAL PERMIT <br /> (*Note:Some pennits may require approval by the Building Official anti/or Public Works llepartment*) <br /> (ALL PERMITS- Mav be subtect to further review and mav not be issued when the apulication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pern�its by mail or in person at the City of�ices. <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 co�ltractors only. <br /> 6. Contact the Public Works Department(452-249-460O)for utility stub as-built loeations. <br /> DO NOT EXCAVATE IN ANI'STREET AND DO NOT TAP ANY MAIIV 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)249-4600,2A+hour notice required. <br /> TYPE OF PERMIT <br /> (Check A111"hat Apply) <br /> �Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection ❑Re-Connection ❑Repairs �isconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site / Owner Information: <br /> Site Address: � } �� �►y��' � � � <br /> ` � r 1 �i�;E�i ��'�r �s'��LLi�'l.. <br /> Owner: ,� j t Z, �,� {— Mailin�;Address: �,� � L <br /> Clly: tJ� ��.�� Zl[�: � ��( � <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> �� <br /> Contractor: ��"L�+'���'� ����-�r l �'• �C�ontactPerson: ,�'� � ��'�J9` <br /> Address: �� ��''` Z y � State License#: �y,� ���`� <br /> City: ��r"� ��° Zip: s���xpiration Date: j � � �' <br /> Phone: � �2 �f � �� ��� Alternate Phone: <br />