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. <br /> ,����'^..� FOIg��SE ONLY <br /> 0� Clty of Orono Date Received: Peranit# �� <br /> � '� P.O.Box 66 <br /> ! 2750 Kelley Parkway ❑In-_ �e SAC Aetermination F rm ompleted ��►L✓ <br /> ��,s� ��' Crystal Bay,MN 55323 � <br /> \``�� ,�� (952)249-4600/Fax(952)249-4616 Appro�ed By(I�'�equ�d� I b�lP��P q zr �{'�� <br /> \�'��c s�i�¢� <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Departrnent•) <br /> (ALL PERMI'I'S- Mav be subiect to turther review and mav not be issued whea the ao�licAtion is receivedl <br /> GENERAL INFORA�iA'TIOIV <br /> 1. You may apply for utility permits by mail or in person at the City of�ices. <br /> 2. Mailed in applications aze subject to the postage and handling fee shown below. Pernut 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. VJork must not begin unless the permit card is available on the job site. <br /> 5. Urility 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 ANfl 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 i <br /> [�J Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> .� <br /> ❑ New Connection ❑Additional Connection Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connecri n For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: <br /> �31 `� � �a� ��; L: r <br /> Owner: !�,.,�t' .t �,t E F _ Mailing Address: �� AC��,�,�rS� <br /> City: �n:r��_���IGa, Zip: �r,��c� <br /> Home Phone: ��,- q- ���� Alternate Phone: <br /> Contractor Information: <br /> Contractor: ['.a(��^ 5 ;,��� � Wc�,�el Contact Person: �'�;\� �p p;,� <br /> Address: �(��-1 Gi�C;;,� ��� State License#: J,5 � �a�' !�1 f� <br /> City: u�a�-�( �1� Zip:S� Expiration Date: 1 Z.-3�' �L^ <br /> Phone: �\�- �sb�r3--q�1� Alternate Phone: <br />