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� <br /> � <br /> ,�.�1 j��5�- <br /> � FOR CITY USE ONLY � <br /> ' jl�`�'�, City of Orono Date Received; Permit# � <br /> ,�0� '�4, P.O.Box 66 �� <br /> t >1;,,,_,. � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed �7 <br /> � }�1'l�.'. a.� Crystal Bay,MN 55323 � �,�(p� � <br /> `\�'��'��f�:,;��ofi (952)249-4600 Approved By(If Required): � ��", I� <br /> ���.g•� � �a- <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 uot 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 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 /> ,�,�esidential(May Require Approval) �Commercial(Approval Required) <br /> �New Connection ❑Additional Connection a Re-Connection �Repairs ❑Disconnect <br /> Job Site/Owner Information: <br /> Site Address: 3083 �a-� r��trJ L�� <br /> Owner:Ca-�'D��/'t B�¢�/'S Mailing Address: <br /> c��y: dr�v z�p: �53a 3 <br /> Home Phone:�152-4-15-13810 Alternate Phone: <br /> Contractor Information: <br /> Contractor: Glenn Rehbein Exc, Inc. ContactPerson: John Carlisle <br /> 8651 Naples Street NE <br /> Address: State License#: �d�o.�g8 <br /> City: Blaine Zip:5541,9 ExpirationDate: �z�3//D7 <br /> Phone: (612) 919-2019 Alternate Phone: (763) 784-0657 <br />