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� r ' � <br /> FOR CITY USE NLY <br /> ,��� City of Orono Date Received�i�.-'���/ ermit# 020/.'�O/o7� <br /> O \ O P.O.Box 66 <br /> �,; a 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> a �y'���,���_ � Crystal Bay,MN 55323 <br /> �� ',�;��t�'.�o (952)249-4600 Approved By(If Required): <br /> �sexo$ <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 PERMITS- Mav be subiect to further review and ma�-not be issued when thc application 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 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 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-Connecrion ❑ Repairs ❑ Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site / Owner Information: <br /> Site Address: �G1 � ►'�CC'�'� rl� �C��-� ��S'��� <br /> /�.�t �T..�� <br /> Owner: ���ri2. ��n�.--� Mailing Address: <br /> City: �'4��1r��..��r��--� ;ti�rL � Zip: <br /> Home Phone: Alternate Phone: �S�7�� ����"�`�`' <br /> Contractor Information: <br /> Contractor: u� �fir Contact Person: r� �,C�I�Z''�`� <br /> Scv,��r'vrkr�/� � ,� <br /> Address: �(��� .���� S� State License #: _3 Yc!_S� <br /> City: _S�.�'�✓e�,�/ Zip:��3�Expiration Date: � <br /> Phone: �/,,�- :����-5��� Alternate Phone: �i'��7� <br />