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— FOR CTI'Y USE ONLY <br /> %��/�/� City of Orono Date Received: Permit# <br /> P.O.Bax 66 <br /> /1' - 2750 Kelley Parkway ❑tn-House SAC Determination Form Completed <br /> �) Crystal Bay,MN 55323 <br /> '�� �'� (952)249�600/Fax(952)249-4616 Approved By(If Required} <br /> 9A/�II�iP�`` <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Departmen[') <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the anolication 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. Pernut 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 Warks 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 A 1 <br /> �esidential(May Require Approval) ❑Commercial(Approval Required) <br /> �ew Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Info�mation: <br /> SiteAddress: � ! � �`�� ��i�� �v <br /> Owner: ���n�' vV��U Mailing Address: <br /> c��: W�Y Z�� z�p: ���1 � <br /> Home Phone: ���l ��b� G��uU Alternate Phone: <br /> Contractor Information: <br /> , (� � <br /> Contractor: ��I I I� `�5���', Contact Person: C ��'" �) <br /> l p � � <br /> Address: I I�I�` G� "� J State License#: �b <br /> City: ��� Zip:' 1�I� Expiration Date: •' 1�_1 I "�� f� <br /> Phone: - I`�a ��" C���3 Alternate Phone: �I�Y ��� I 7c70" <br /> �nS <br /> �e(,����1 �r- �a-� ,. /V�o���,�� �h{ l�l}� � ���r n��n U�,,�� a'�3� <br />