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FOR C►TF IiSE OtiLl' <br /> �,�Q�O City of Orono Date Received Pennit# <br /> P.O.Box 66 <br /> � 2750 kelley Parkway ❑In-House SAC Determination Form Completed <br /> a • �' Crystal Bay.MN 55323 <br /> �'d+ ''�� . o' (952)249-a600 Approved By(If Required): <br /> "'Ksexo���� <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (°'Note�.Some permits may require approval by the Buildii�g Official and/or Public Works Departmcnt") <br /> (ALL PER�lI7 S- !�9�� be subiect to further review and mav not be issued when the aoplication is receiced) <br /> GENERAL INFORMATION <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. lssuance 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 I <br /> ❑■ Residential (May Require Approval) ❑Commercial(Approval Required) <br /> ■❑ New Co��nection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> s�te aaaress: 3980 Cherry Ave (PID #08-117-23-33-0026) <br /> oWner: Kevin & Mandy Sehultz Mailing Address: 5620 Girard Ave N <br /> Cit : grooklyn Center, MN Z1 55430 <br /> y p� <br /> Home Phone: �612� 710-4656 Alternate Phone: <br /> Contractor Information: <br /> Kothrade SWE, Inc. Glen or Pam Kothrade <br /> Contractor: Contact Person: <br /> 12059 Whitetail Lane Plmbrs Bond 8 Ins Cert#57399MR <br /> Address: State License #: <br /> Hanover, MN 55341 <br /> City: Zip: Expiration Date: <br /> Phone: (763) 498-8702 Alternate Phone: (763) 498-0070 <br />