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FOR CITI'USE ONLY <br /> �O;¢(�,j O\ City of Orono Date Received: Permit# <br /> `�` P.O.Box 66 <br /> �� �,;; � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> � ,i,��r�,,:�. �. Crystal Bay,MN 55323 <br /> '�'?�n��y,G` (952)249-4600 Approved By(IfRequired): � <br /> �t??�Q��'� <br /> `— __- <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 PERM]TS- Mav be subiect to further review and m�v not be issued when thc anplication ic received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utiliry 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. Wark 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. Contaet 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 worh must be done in accordance with State Code requirements. <br /> 8. All �vork 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 /> �Residential (May Require Approval) � Commercia](Approval Required) <br /> �New Connection �Additional Connection � Re-Connection � Repairs �Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: � �P t 1 � � � �-�` <br /> Owner:�����-�0����� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Infonnation: � <br /> Contracto .• " `�l ���'�-� Contact Person: C <br /> � <br /> r--�-- �7 G <br /> Address:� �� / !����l2-- �tate License#: _� l � �-- <br /> City: �l� Zip�7 7�y�piration Date: �� �� U � <br /> Phone:��� �7� �7� �`I Alternate Phone: � l��� � ���7 <br /> / <br />