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. <br /> FOR CITY USE ONLY <br /> /¢��\ City of Orono Date Received: Permit# <br /> / P.O.Box 66 <br /> �jl�;; ��� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> j�� �n ��- �� Crystal Bay,MN 55323 <br /> � � .o�%� (952)249-4600 Approved By(If Required): <br /> ���oij% <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 mav not be issued when the apnlication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mai]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 A 1 <br /> [�Residential(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: �� ��('���U :, e_� ��- <br /> Owner:W�,�J�_`;,�;,�n Mailing Address: � o�S �t�C>.St u�e� t�vz <br /> City: �`�jCs Zip: �S�S,C� <br /> Home Phone: Alternate Phone: Ej�a'�� -a`��a <br /> Contractor Information: <br /> Contractor: Cpo�„�Q1 �� +�;��,�( Contact Person: g;�\�;','\ <br /> Address: �(��l (�1�,:��Q�� State License#: �7��`�-M(� <br /> City: i,���uPi�,�1 Zip:�Q Expiration Date: l�-��-�v2 <br /> Phone: ��c1'��$�\5�� Alternate Phone: ��a'Sc�`�-9�l�F <br />