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FO CIT USE ONLY nJ <br /> ,��� Clty of Orono Date Received� o�—Permit# (�� ' �(�/� <br /> P.O.Box G6 <br /> ��;;,.ti � 2750 Kelley Parkway ❑ In-House SAC Determination Form Completed <br /> � �1'������,�. !� Crystal Bay,MN 55323 <br /> t�������d�� (952)249-4600 Approved By(If Required): <br /> CITY OF ORONO- SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may rcquire approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subicct to further review and mav not be issued when the annlication is received) <br /> GENERAL 1NFORMATION <br /> L 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 pernut 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 loeations. <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 pernut 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 /> ❑ Water Availability Connection Far Future Hook-Up to Water <br /> Job Site / Owner Information: <br /> Site Address: ���� !.;.Y-}1-}(_._, ¢�-� _ <br /> Owner: �c'- �`�i�G�/ Mailing Address: ��'�y� t�r9HC- f� <br /> City: L/(��!-O Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: J S 5'c�L�?(�� �PArV i�S Contact Person: J�, G't�l, ��J�9(-� <br /> Address: ��d J� �1Ylc�-��/�'� State License #: <br /> City: vV� Zip:``j�`�� Expiration Date: <br /> Phonee ?4�3 �Z4 ��%'.�� Alternate Phone: �IZ 3� �v '�'�� <br />