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. <br /> [ Y SE ONL II" ] <br /> 4�^lO� City of Orono Date Receive ; / Pertnit i{ U/(c !%� �7 / <br /> P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC Deterntittation Form Completed <br /> s Z Crystal Bay,MN 55323 <br /> `a � (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> �KtSHO�'t <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> ('Note:Some permits mny require approval by lhe Building Oflicial and/or Public Works Department') <br /> (AGI.P£R�,tITS- Mav be subiect to Porther review and mav not b�issued when Ihe analication is receivedl <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 ANTD DO NOT TAP ANY MAIIY without e:press <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) ���� ���, h��-Qi�l� <br /> Uv«..�� <br /> New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect� �,,�.(��/' <br /> ❑ Water Availability Connection For Future Hook-Up to Water � �� �1Y�`�u' <br /> Job Site/Owner Information: o�N�� • <br /> Site Address: �Q �f'a X �. <br /> Owner• Mailing Address: <br /> City: Zip: ` � ` . <br /> !� <br /> ,�� , �b - . <br /> Home Phone: Alternate Phone: � <br /> Contractor Information: J � <br /> �� � �.c <br /> Contractor: �i�P�rson: v <br /> Address: ���1 ,,,�hc��X.'fCu L�S te License#: ��"!� <br /> ( -�,�� <br /> City: � Zip:�,�.t. � Expiration Date: <br /> Phone: �((�,t.1�'l0, (\ l�- Alternate Phone: <br />