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. <br /> FOR CITY�USF ONLY <br /> p`�� City of Orono Date Received: Permit# <br /> /O¢�`�`O�; P.O.Bo�66 <br /> i �; �ti 2750 kelley Parkway ❑In-House SAC Determmation Form Completed <br /> ���� �(" �� _ �� Crystal Bay,MN 5�323 <br /> ���t 1r �,v yt`f (952)249-4600 Approved By(If Required): <br /> �„iggp4.-% <br /> CITY OF ORONO-SEWER & WATER/GENERAL PERMIT <br /> (*Note,Some permits ma}'require approval by the Building Official and/or Public Works Department*) <br /> (AL1,PERI�IITS- Ma��bc subiect tn further review and mav not be icsued whcn the aoplication 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 A 1 )� <br /> �Residentia] (May Require Approval) � Commercial(Approval Required) <br /> � New Connection ❑ Additional Connection � Re-Connection (� Repairs ❑ Disconnect <br /> Job Site/Owner Information: C� "J � ��1 �� �, J ��� <br /> �� <br /> � /� ��� <br /> Site Address: � � � /���.Q/ w�/y/��2 l'�-L ,o <br /> - l� <br /> Owner: � � �t� 7� S� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Infor�nation: <br /> a�- � <br /> Contractor:���� �� � Contact Person: � <br /> Address: �? � / %��� � �!2 State License #: � � Z- � <br /> /� v <br /> City: ����1�-G� Zip:�5 '7 Expiration Date: / � 3� D � <br /> Phone: � La � �7 � (v 7 I � Alternate Phone: �p / � J/ � �� y� <br />