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. � �, <br /> -EOR CITY USE ONLY <br /> ��� City of Orono Date Received Permit# <br /> P.O.Box 66 <br /> �� � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> a �Il���� �' Crystal Bay,MN 55323 <br /> �� �; u `�o o~ (952)249-4600 Approved By(If Required): <br /> t��th�'��,s <br /> '�sexo <br /> CITY OF ORONO— S�WER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Ofticial and/or Public Works Depar[ment*) <br /> (ALL PERMITS N[av be subiect to Curther review and m�v not be issued when the annlication is reccived) <br /> GENERAL INFORMATION � <br /> 1. You may apply for utility pennits by mail or in person at the City offices. <br /> 2. Mailed in appiications are subject to the postage and l�andling fee shown b�lo�v. Pernut cards will <br /> be sent by rettu-n 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 coiuiection permits may be issued to licensed coiihactors only. <br /> 6. Contact the Public Works Department(952-249-4600) for utility shib as-built locarions. <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 pemut does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> S. All work inust be inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> TYPE OF PERMIT <br /> (Check All That ApP1Y) ', <br /> �] Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> � New Connection ❑ Additional Connecrion ❑Re-Connection ❑Repairs ❑Disconnect <br /> Job Site/ O�mer L�.formation: <br /> Site Address: � S � .LL��� �� <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> � <br /> Contractor�D� � � Contact Person: !V �. <br /> Address: � 7 S t,��� � State License#: �l��- <br /> City: � Zip: ��3 7�;xp;ratioi�Date: / � � ` � � <br /> Phone: � / � 9/���,� Alternate Phone: ������z_�� � <br /> ...�' <br />