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� <br /> roK crr��usr o�Lv <br /> '� City of Orono Date Received: Perntit# <br /> „%/�¢��\`` P.O.[3o�66 <br /> (��t;,,.,� Q��7 27�0 helley Parkw�ry ❑In-House SAC Determin tion Form Completed <br /> ',��� �1��� �� crys��i r�ay,MN;s3z3 ,S�}c f'� �.'���13�.8"3 <br /> ���K�xp4�o i (9�?)249-4600 Approved By(If Rcquired): <br /> CITY OF ORONO— S�WCR & WATER /GEN�RAL P�RMIT <br /> ('\otc:Somc pern�its may rcquirc approv�l by thc Building Ofticial and/or Public Works Departmcnt*) <br /> (;\LL PGR\II"I S- �lat 6c suhiect to furtl�cr revic�� :�nd m;i�'not be issuecl�tihen the;�t��>lica�ion ic recci��ed) <br /> GENERAL INFORMAI'ION <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> � 2. Nlaifed in applicatioiu are subject to the postage and handlii�� fee shown below. Permit cards�vill <br /> be sent by ret�u�n mail within 2 business davs. <br /> 3. Permits are not valid witi!you receivc a permit c�rd. � <br /> 4. ���orl: must not begin unless the pennit card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> G. Contact the Public 4Vorks Departn�ent(952-249-4600)for utility stub as-built� locetions. <br /> DO NOT E\CAVATE ln`r�nY STR�ET ANU DO NOT 1�r1P ANY I��IAIN without express <br /> approv�l of thc Public �Vorl:s Dep�rtment Issuance of a permit does not grant this lpproval. <br /> 7. All worl:must be done in accordailce with State Code requirements. <br /> $. All worl:must be inspected �efore it is covered. Cafl (9�?)?�i9-=}ti00,24+hour eiotice requirccl. <br /> TYPC OP PERNIIT <br /> �;:hecl<All Z hat n l ) <br /> �Residcntial (I�9ay Reqtiire Approvll) � Commercial (Approval Required) <br /> �\'e�i�Connection �, Additional Connection � Re-Connection �OJ Kepairs � Disconnect <br /> Job Site/ Owner Information: I <br /> � <br /> Site Addcess: � 's I � �� ���-- , j�l� { �����JJ��= <br /> _..r---�- -, (� <br /> U���i1er. �£��'+�Atil',� �- �lJ�. ivlaiiiil� Aciciress: ��,� !�� '�� �� � <br /> � � <br /> City: b�C�v1�: 7ip: �`����� <br /> qsz-�7�- �' I 1 `� %'z-�7C�-�.2��� <br /> Hoi��e t'ho��e: �^ Alter�late Phone: � <br /> � Contractor Information: I <br /> � I --"' � f <br /> Contractor: � ( � �� Coiltact Person: �� �)�`�"�C� <br /> Addi-ess: ������ � � �"J State Liceilse #: � � �1 <br /> City: � 7ip;j�;���piration Date: i Z—D� <br /> � � �G`3-�+�?��-l�y-? -� -�- <br /> f 11onc: � Alt�ernate Pllone: �-_�-� 5 7 <br /> �j �Z �/�l D�7`�5- <br />