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. . _1.,. <br /> F(�ji C1TY USE ONLY <br /> �n/V� City of Orono Date Received: �rcr►n�c#.�_ (, I��_C' �� ��7� <br /> P.O.Box 66 <br /> 1 2750 Kelley Parkway ❑In-House SAC Determinatiou Form Completed <br /> crys��say,�r ss3z3 �/l��� f�� 1 C f �•(� ���j�' �, � _��� � <br /> l'i,� �, � (952)249-4600/F�(952)249-4616 ApProved By(If Requu� � <br /> ar,u��"� <br /> CITY OF ORONO- SEWER& WATER/ GENERAL PERMIT <br /> ('Note:Some permits may require approval by the Building Ofticial and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mxv not be issued when the aoolication 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. 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 Depariment(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 /> ❑New Connection ❑Additional Connection �Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: �� � �� � �������'�r ��� ����� ����� <br /> � ��I E�1�� �1�� c�rt,� �ir+�-5��� <br /> Owner: 1�� ���� �� Mailing Address: ��1 <br /> M � , <br /> ���: , �l�r-��t�V�l�� Z�p: � S��i.� <br /> Home Phone: G+�����)��^����t`� Alternate Phone: <br /> Contractor Information: <br /> � <br /> Contractor: I...��I I � q n� Contact Person: ���� ���'� <br /> Address: 4��IJ� W �V -� State License#: <br /> City: �\I����S Zip:L����� Expiration Date: <br /> Phone: ��'q S?� `�I`� Alternate Phone: �� �- � ��`� � 0 <br />