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! <br /> FOR CITI'USE ONLY <br /> ' � City of Orono Date Received: Permit# <br /> �gO��� P.O.Box66 <br /> '� " �`��}+� 2750 Kelley Parkway � � <br /> , �, ❑In-House SAC Determinahon Form Completed <br /> �� q^ � �tt Crystal Bay,MN 55323 <br /> d����yo`� (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 /> (AI.L PF.RMITS- '11av be subiect to further review And m�v nat be issued when the application 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 thejob 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 notiee required. <br /> TYPE OF PERMIT <br /> (Check All That A 1 ) <br /> �Residential(May Require Approval) � Commercial(Approval Required) <br /> � New Connection ❑ Additional Connection � Re-Connection � Repairs ❑ Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: 3,Z�1�' �`,,�-,�'rn E:�,.. �� <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: �/���rL��m /i'G���� Contact Person: (/`-'�-����c�C /�/(�e� <br /> Address: / State License #: ��i'v`/� <br /> City: � aw.v Zip: 5,33b'f�Expiration Date: /,.2 —.3J —0 7 <br /> Phone: �/� �.3G:_3 �/y"�' Alternate Phone: <br />