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_ . � ��o �-� <br /> ` FOR CI�'Y USE ONLY <br /> ��� City of Orono Date Received: ��1� Permit# �L��L <br /> P.O.Box 66 <br /> ��;;.�,,, � 2750 Kelley Parkway '❑In-House SAC Determination Form Completed <br /> a j?s%�z�L � Crystal Bay,MN 55323 <br /> ��l�'����i���o` (952)249-4600 Approved By(If Required): <br /> '�$sxo <br /> CITY OF ORONO -S�WER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Ofticial and/or Public Works Department*) <br /> (A1 L PERMITS- MaV be subiect to further review and mav not be issued�vhen the annlication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pennits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will <br /> be sent by rehirn mail within 2 business days. <br /> 3. Permits are not valid until you receive a pernut card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Utility connection pernuts may be issued to licensed conri-actors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility shtb 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 Apply) <br /> Residential(May Require Approval) ❑ Conunercial(Approval Required) <br /> ❑ New Connection ❑Additional Coimecrion �Re-Connection ❑Repairs ❑Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: �--���� ,1J�K- �� � � �`-�1� � �Z <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> --� �- _ ��` � <br /> Contractor: ��, � � S C�w��� Contact Person: �S S � <br /> � <br /> Address: ��U�J L �"^��-��"5tate License #: C��� <br /> City: �-�6�'�� Zip: '���L��Expiration Date: <br /> Phone: �(o�"L�z�`�lU �U Alternate Phone: ��z - 3� � `��� <br />