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v <br /> � � FORI�USE ONLY� ����� � <br /> 40,�` City of Orono Date Received:`" Permit# t <br /> `� P.O.Box 6G <br /> �� �,,,. � 2750 Kelley Park�vay ❑In-House SAC Determination Fonn Completed <br /> a '�����;�1L � Crystal Bay,MN 55323 <br /> �� �' u� o~ (952)249-4600 Approved By(If Required): <br /> t���(P�� <br /> '�saHo <br /> CITY OF ORONO—SEWER& WATER/ GENER.A.L PERMIT <br /> (*Note:Some permits may require approval by the Building Ofticial and/or PuUlic Works Department*) <br /> (ALL PERMITS- A7av be sublect to further review and mav not be issued when the apnlication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pennits 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 wi11 <br /> be sent by rehirn mail within 2 business days. <br /> 3. Pernuts are not valid until you receive a pernut card. <br /> 4. Work must not begin ui�less the pernut card is available on the job site. <br /> 5. Utility coimection pernzits may be issued to licensed conti�actors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. <br /> DO NOT E�CAVATE I\�ANY STREET AND DO NOT TAP ANY MAiN�vithout express <br /> approval of the Public Works Department. Issuance of a pernut does ilot grant this approval. <br /> 7. All work must be done in accordance with State Code requuements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> : TYPE OF P�RMIT _ <br /> (Check All That ApplY) <br /> ❑Residential(May Require Approval) ❑ Conmzercial(Approval Required) <br /> ,[x] New Connection ❑Additional Coimection ❑ Re-Connection ❑Repairs ❑Disconnect <br /> Job Site/ Owner I��formation: <br /> Site Address: o�.S �j ���w���,� <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor:4/c��� �rr LGC ContactPerson: �--� l✓�-��J�-�dl''��� <br /> Address: �'y�v� �� �<<�-S � State License #: <br /> City: /h�-�l�%�/�'� Zip;SSJ��xpiraticn Date: <br /> Phone: ���r�� ��C� Altei�late Phone: 6�0'�5�� —�CG� <br />