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, . <br /> FOR CITY iJSE ONLY <br /> ,�Q� City of Orono Date Received: Permit# <br /> � P O.Box 66 <br /> ��;; �� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> ��� �t?� R,` �. Crystal Bay,MN 55323 <br /> �t"��x��t�.�.}yL`l (952)249-4600 ApprovedBy([fRequired): <br /> `-��p1/ <br /> CITY OF ORONO— SEWER & WATER/GENERAL PERMIT <br /> ('`Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PF,RMITS- Mav be subiect to further review and mav not be issued when the application is received) <br /> GENERAL INFORMATION <br /> l. 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. 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 notiee required. <br /> TYPE OF PERMIT <br /> � � ��� (Check All That A � l ) <br /> �Residential(May Require Approval) � Commercial (Approval Required) <br /> � New Connection ❑ Additional Connection � Re-Connection �Repairs ❑ Disconnect � <br /> Job Site/ Owner Information: <br /> -'���� ��� �� �% �� <br /> Site Address: � � � ���y <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Infor�nation: <br /> Contractor: }%�z--1 ��-��� Contact Person: �Z��C �� /�� <br /> Address: ��� State License #: <br /> City: � Zip:����` Expiration Date: <br /> Phone: �_S� y`��p�vzy Alternate Phone: <br /> �'�,z 363��1 YE� <br />