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� � �� � <br /> . ����; <br /> FOR CITY USE ONLY � ��� <br /> 0 �City of Orono Date Received: Pem�it# �� <br /> ¢ � P.O.Box 66 � <br /> �" � 2750 Kelley Yarkway I ❑In-House SAC Detemiination Fonn Completed <br /> �;,c w,_ <br /> '�j!'i�,�c�: � Crystal Bay,MN 55323 <br /> �a ��'?�}j���. o` (952)249-4600 Approved By(If Required): <br /> t'�sexo�" <br /> CITY OF ORONO — SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by tl;e Building Official and/or Public Works Department*) <br /> (ALL PER�IITS blav be subiect to further review and mav not be issued�vhen the annlication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pennits 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 rehu'n 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 pernut card is available on the job site. <br /> 5. Utility comiection perinits may be issued to licensed conh�actors only. <br /> 6. Contact the Public Works Department(952-249-4600) for utility shib 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 pemut 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 Apply) <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑ Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: 7�v I �b�C ��'�f� ,��� <br /> Owner: �i�'�l/'���� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor In rmation: <br /> �----� � <br /> Contractor: "D � ���c� Contact Person: ,,.�<<� /�-��1�� <br /> ,� ` �_, <br /> Address:���� �� t.J�J� �� State License #: � / � <br /> City: �Y! — :'-� Zip��xpiration Date: / � � / �� �' <br /> Phone: �CO ���� lD �/� Alternate Phone: �� T, � / � � �`� j <br />