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� ///���...��� <br /> + �I� � <br /> ��O�OY C US�ONLY J� <br /> � Clt of Orono Date Receive� per�►it# �D/Gr ��9C,/ <br /> r t P.O.Box 66 <br /> � ' � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> l y� �-� Crystal Bay,MN 55323 <br /> \\�ts�io¢F,� (952)249-4600/Fax(952)249-4616 Approved By(IfRtquired): <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permiu may require approval by the Building Official and/or Public Works Departrnent') <br /> (ALL PERMTI'S- Mav be subiect to further review and mav not be issued w6en the aoolication is receivedl <br /> GENERAL INFORIvIATION <br /> 1. You may apply for urility 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 retum 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. Urility 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 ezpress <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 PER.IviIT <br /> Check All That A i <br /> `�Residential(May Require Approv�) � ❑ Commercial(Approval Required) <br /> ( " �i "iG'' ���.�'.ti Q��(s� `�:'7 �C i r� (f"1 <br /> /� <br /> ❑ New Connection "�Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner In�o�ation: <br /> ' � J � ��'��� � �� <br /> Site Address: ` <br /> Owner: (�Z�Gf ��/Li�� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Inforrnation: <br /> ., � � <br /> Contractor: l�'� S� vr �� � Contact Person: r �G`� �4 f <br /> Address: �i'JC� C�� y�� �� State License#: <br /> City: ��`1 � Zip:J�3��Expiration Date: <br /> Phone: ��.�'���— ��� Alternate Phone: ��� / � �� <br />