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♦� � i \ <br /> 7 <br /> � FOR CITY IISE ONLY <br /> � ' City of Orono Date Received: Permit# <br /> �O'g' �0,. P.O.Box 66 <br /> � 2750 Kelley Parkway [�In-House SAC Detemunation Form Completed <br /> � n}�• �� Crystal Bay,MN 55323 <br /> \�,,d•J.yc,� (952}249-4600 I Approved By(If Required): <br /> �w i <br /> CITY OF ORONO—SEWEIZ&WATER J GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Offic�al and/or Public Works Department•) <br /> (ALL P�RMTI'S- Mnv be subiect W further revlew and mav not be Issued when the aoaGcation Is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permi+s by mail or in person ax the City offices. <br /> 2. Mailed in applications aze 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 uotil you reredve a permit card. <br /> 4. Work must not begin unless the permit cazd is available on the job site. <br /> 5. Utility connect�on permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locarions. <br /> DO NOT EXCAVATE IN ANh'STItEET AND DD NOT TAP ANY MAIN without express <br /> approval of the Public Works Depar[ment. Issuance of a permit does not grant this approval. <br /> 7. All work must be done in accordance with State Code requicements. <br /> 8. All work must be inspected before it is covered. Call(952}249-4600,24+haur notice required. <br /> TYPE OF PERMIT <br /> (Check All That Apply) <br /> �Residential(May Requiee Approval) �]Commercial(Approval Required) <br /> � ' <br /> ❑New Connection ❑Additional Connection ❑Re-Connection �Repairs �Disconnect <br /> Job Site/Owner Information: <br /> Site Address: .�70� ��t� �� ��t , <br /> , <br /> � <br /> Owner: ��-��i'n,..� �1:✓�'e%t Mailing Address: �y�%-� �l'�.�/�-� �� �� <br /> city: e%'�,�a Zi Ss39/ <br /> P� <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> � <br /> Contractor: �p]�- ���7�r' Contact Person: !��( ��S f <br /> Address: %�/53 J ��� �'� State License#: <br /> City: I/ ✓hr.�.� Zip:.S Expiration Date: i��'/�J 5 <br /> Phone: 7l�� j 1 y- ��Z�% 7 Alternate Phone: 7��� �J`3 �.S 1/S <br />