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� ,� <br /> —' —���� � FOR CITl'US�ONLY� � � - <br /> i�g-��/\� City of Orono Date Received: Pern�it# <br /> � �\ P.O.Box 66 � <br /> i� � � <br /> l 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> l��\. `% Crystal Bay,MN 55323 <br /> ``"�� �/ (9�2)249-4600 � Approved By Qf Required): <br /> \,��t��Fr����: <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 aoplication is received) <br /> GENERAL INFORMATION " <br /> � <br /> 1. 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)far 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 accardance with State Code requirements. <br /> 8. All work must be inspected befare 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) ❑ Commercia](Approvai Required) <br /> 4 New Connection ❑ Additional Coru�ection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> ❑ Water Availabi(ity Connection For Future Hook-Up to Water <br /> Job Site / Owner Information: <br /> Site Address: <br /> ���t� ��f���� s� <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: � <br /> c �' <br /> Contractor: ��S��'�`�S _S� � Contact Person: ��4�` ���� <br /> Address: ���� Ct� ,�`� � �S State License #: <br /> City: �Ou�'1� Zip;�,�� Expiration Date: <br /> 7� �s� C��e ���_���5 <br /> Phone: ���� �"�( AlternatePhone: <br />