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f ' <br /> e • <br /> • FOR CITY USE ONLY <br /> �,►` City of Orono Date Received: Permit# <br /> � `Y P.O.Box 66 <br /> ��„ � 2750 Kelley Parkway ❑In-House SAC Detern�ination Form Completed <br /> a j�'����; � Crystal Bay,MN 55323 <br /> � ���i�..�o~ (952)249-4600 Approved By(If Required): <br /> �'tssao� <br /> CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval Uy the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issucd when the aoplication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pernuts by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will <br /> be sent by retuin 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 pemut 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 peimit does not grant this approval. <br /> 7. All work must be done ui 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 /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> Job Site/ Owner Information: <br /> ��Site Address: �f;� � � c�'S<<-' �a�� `� � <br /> Owner: ��� C �,�fJq��a���;�..-• Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> -� l� ' f�� l �C <br /> Contractor: � � :� (,� Contact Person: r ��� � �'� <br /> Address: �C�� � � � � State License #: "1 ��' �� <br /> � � � <br /> City: ✓�th.�v l Zip: �5�`�Expiration Date: ��- 3�-41S <br /> Phone: �i � ��7�-�{ �' Alternate Phone: ��Z ���(I - `� 7� I <br /> � � � <br /> r <br /> % : � <br /> , s <br /> , � 3, <br /> � `� � �� � "`��' � � _ <br /> _ , . '� , <br /> � I <br />