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� <br /> FOR CITY USE ONLY o3� � <br /> �� �� City of Orono Date Received: Permit# �!O � <br /> ,�g�a�j;=, <br /> P.O.Box 66 <br /> "�� ���` 2750 Kelley Parkway ❑[n-House SAC Determination Form Completed <br /> � }��� '�) Crystal Bay,MN 55323 <br /> ' � � t}•o�'� (952)249-4600 Approved By(If Required): <br /> '�'x <br /> �'�ib8��4, <br /> CITY OF ORONO- SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the application is received) <br /> GENERAL INFORMATION <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 permit 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 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 A 1 � <br /> �Residential (May Require Approval) ❑Commercial(Approval Required) <br /> Q New Connection ❑Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site /Owner Information: <br /> Site Address: 550 East Long Lake Road <br /> Owner: David Netjes Mailing Address: 500 Navajo Road West <br /> Cit Medina Zlp: 55340 <br /> Y� <br /> (763)473-4531 (763) 742-7061 <br /> Home Phone: Alternate Phone: <br /> Contractor Information: � <br /> Burns Excavating, Inc. Steve Burns <br /> Contractor: Contact Person: <br /> 3470 County Road 21 <br /> Address: State License #: <br /> City: Mayer Zip:55360 Expiration Date: <br /> Phone: �952) 955-3112 Alternate Phone: �612) 685-4303 <br />