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� <br /> � <br /> FOR CITY USE ONLY <br /> ¢0,�` City of Orono Date Received: Permit# <br /> "r P.O.Box 66 <br /> ���; � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> a ��t���� �* Crys[al Bay,MN 55323 <br /> �� ��� ��o~ (952)249-4600 Approved By(If Required): <br /> t�FeK$� <br /> CITY OF ORONO-SEWER& WATER/ GENERAL PERMIT <br /> (*Notc:Some permits may require approval by the Building Ofticial and/or Public Works Department*) <br /> (ALL PERMITS- NIaY be subiect to further review and mav not be issued whe�the application 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 applicarions are subject to the postage and handling fee shown below. Permit cards will <br /> be sent by renun mail within 2 business days. <br /> 3. Permits are not valid until you receive a pernut card. <br /> 4. Work must not begin unless the pernut card is available on the job site. <br /> 5. Utility co�mection permits may be issued to licensed conhactors 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 VVorks Department. Issuance of a peinut does not 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 requirecl. <br /> TYPE OF P�RMIT <br /> (Check All That APP1Y) <br /> � Residential(May Require Approval) ❑ Conm�ercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection [t�e-Connectiou ❑Repairs ❑Disconnect <br /> 7ob Site/Owner Information: <br /> Site Address: � ` � �v ��1-e�` n`� �+�C� <br /> Owner: �� � 1�� ��v1•'��(/� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ����y��� Contact Person: �f � �1 <br /> Address: �5 �-'l �'O � I S� State License#: � D�('`I �,���1 <br /> City: �Y��v''� Zip:S 5 3�`� Expiration Date: �� - � �- � � <br /> P11one: �( ��- ��� Z - ��� � Alternate Phone: ` S a - ��L - ���P� <br />