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Apr-11-2012 08:48am From-CITY OF ORONO +9522d94616 T-511 P.0�1I002 F-365 <br /> FAit'CITX TJS�:QN1�X ' <br /> [aatp Roccived` •,,,;,._� �'vr�nit� ;,.,-„—.� <br /> City of Orono , ,- <br /> '�O�'�'�'O p_�.Dox 66 Q bn I-Iouse SAC De�emiin��;�x,Aorn�Completed <br /> 2750 Kellcy parkway <br /> � �� 5, �, Crys�al day,lviN 55323 Approved Ry(If Re�uired); . ' <br /> ���,��� (9521249s1600 <br /> �Y�CITy QF O�tONO--SEV�VER&c WATEIt/GEl�'ERAL P�R1V�I7' <br /> (•Note:Soma p���Y require apprm�al by thr Building Officinl and�ar Public Wixks Dcp��uixn[') <br /> AL'L £RM S- AC$ BCt I furlh revic.W nd m noc ixsucd on t} 3 licn ���is r fved <br /> y ��+ �*��� �7 ,, . • ' <br /> V�1V l�i\.nl.r�1L`11'�11�-1��1.�'��Ql\ . . . <br /> m�il ar� erson at the City ofiices I <br /> �. 'i'ou may appiy for udlity pernu�s by P <br /> 2. Mailed in applicatiuns are subject to r�e postage and hanc�ing fee shown below. Pernut cards will <br /> be sent by r�rurn maii within 2 business dAys. <br /> 3. Yerrnits are not valid un�i!you rece�vo a pernut card. <br /> 4, Wark must not begin unless the pe������availabie on the job s�ce. <br /> �. Utility connection prrmits ma�be issued to licei�cd canrraetars arily. <br /> 6. Contaet the Pi�blic�Jarks Deparanent(.952-249�b4�)for unliry stub as-l�uilt lucauons. <br /> DO N4T T�..�CCAVATE iN ANY STR�ET AND pQ NOT'�Ap�N�� �thout express <br /> �pproval oi the�'ublic'��orks Degartme�►t. Issuance af a perulit doaS not;x:int this agproval. <br /> 7. All work must be done in accordance with Statc Code requiren�nts, <br /> 8. All work must be inspected Uefc�re it is covered. Gall{9S�)249-46U0,24+hour•auffcc reqtured. <br /> 'T'.yPE OF PERMYT , <br /> (CheckAll That A 1 <br /> �Residentifll{Maq Req�e Appruval) ❑Commercial(Approval Requucd) <br /> �N�w Connection CI A�itional Connection ❑12e-Connection ❑Repairs ❑Diseonnect <br /> [] WatCr Availability Com�ection For�uture l�ook-LJp to Wa�er <br /> Job Site/Ovvn�r In�ormatic►n: � • <br /> Site Address: _ �6 �� (- �S C�� �'���� ��� � <br /> O�wner: Mailing Address: , <br /> City: ,Zip: �- <br /> Home Phone: Alt�rnate Phone: <br /> Contractor Informatioii: . � <br /> , ,C����?/-��L�,�r�«'G <br /> Contractor: ^ ��� -<�'�� Contact Person: <br /> Address: �G � �f'c /�� ' State Li�ense#: ��.�.D 'ys.�o� � <br /> City: <br /> �'���/�,� ���'�/,S�xpiration Date: � � �' -3 <br /> ' ,L < �t��� Alternate Phone: G��� �`3 �����) <br /> Phone� y��_ �����- <br />