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� <br /> � <br /> . <br /> FOR CITY USE ONLY � �j O� i <br /> i'��� City of Orono Date Received: � �� <br /> � �� `.i' Permit# G <br /> �r��. �+. P.O.Box 66 G � �� I7J <br /> �,�.,,,, 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> i <br /> 1j'!'��.'. �� Crystal Bay,MN 55323 <br /> �``�+��k�'�`:,,��o�' (952)249-4600 Approved By(If Required): <br /> '\�// <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 aaalication is received) <br /> GENER.AL INFORMATION <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)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 /> ,�Zesidential(May Require Approval) � Commercial(Approval Required) <br /> �New Connection ❑Additional Connection �Re-Connection �Repairs ❑Disconnect <br /> Job Site/Owner Information: <br /> Site Address: •�8� a ��'Y I �,W LC�-v1 e <br /> Owner I/Yt�+-St,�SQ+'� ��� Mailing Address: <br /> �ity: D r�n c� zip: 55323 <br /> Home Phone: c152'��--72(0-7 Alternate Phone: <br /> Contractor Information: <br /> Contractor: Glenn Rehbein Exc, Inc. Contact Person: John Carlisle <br /> 8651 Naples Street NE <br /> Address: State License#: DO(ov'ZgF <br /> City: Rlaine Zip:5544q Expiration Date: �2 � ��7 <br /> Phone: (612) 919-2019 Alternate Phone: (763) 784-0657 <br />