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' ��.�.� d <br /> CI Y USE ONLY <br /> ��n/� CltyofOrono DateReceive����!'�Permit# �-,d -rl'�/ <br /> P.O. Box 66 <br /> 27�0 Kelley Parkway ❑ In-House SAC Detemiination Forni Completed <br /> '��, i � Crystal Bay,MN»323 <br /> �-'�,�kY�tF����� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> �;ii� <br /> CITY OF ORONO — SEWER & WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by[he Building Official and/or Public Works Department*) <br /> (ALL PER��IITS- llav bc subiect to further review and mav not be issued when the anplication is received) <br /> GENERAL 1NFORMATION <br /> I. 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 Apply) <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: �3 a �� GGvup �• <br /> Owner: Q I�c►�,�.Q, Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: 1�•s•(�'l • �,�-C_• Contact Person: I�l�,� �P /�Yl� <br /> Address: a--9.l� F',�.,�,�.J!�( State License #: a--Z � 8 <br /> City: � Zip: Expiration Date: <br /> Phone: G SI��lBG r�3S� Alternate Phone: � ��'- � ��-��3��G <br />