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I � <br /> � <br /> FOR CTTY uSE ONLY I I ^ <br /> , � `' Cit of Orono Date Received:�1 Permit# C <br /> ��4���, Y <br /> p� P.O.Box 66 ��� <br /> A•,,,,;. 2750 Kelley Pazkway ❑In-House SAC Determination Form Completed �{ � I�Q <br /> i,;�y }�1'�� '. +.� Crystal Bay,MN 55323 D <br /> �,���r�Y�`o� (952)249-4600 Approved By(If Required): ry,l/�'1 <br /> __-s r! <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Offcial and/or Public Works Department*) <br /> (.�LL PERMITS- Mav be subiect to further review and mav not be issued when the application is received) <br /> GENERAL 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 oot valid until you receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> �. 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 egpress <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 /> ,�,�esidential(May Require Approval) �Commercial(Approval Required) <br /> �New Connection ❑Additional Connection �Re-Connection �Repairs ❑Disconnect <br /> Job Site/Owner Information: <br /> Site Address: 3C�b"7 �Gt-li'v(�,�J L-�� <br /> Owner:��✓�+�t olrr�Q F��'� Mailing Address: <br /> city: (7f On l� zip: �S�3 2�_ <br /> Home Phone:�SZ-�I�J(o -�,� 8q Alternate Phone: <br /> Contractor Information: <br /> Contractor: Glenn Rehbein Exc, Inc. ContactPerson: John Carlisle <br /> 8651 Naples Street NE <br /> Address: State License#: 0��8� <br /> City: u�a;,,A Zip:5544q Expiration Date: �2 3� Z�d� <br /> Phone: (612) 919-2019 Alternate Phone: (763) 784-0657 <br />