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RECEIV��� <br /> — F CIT 'USE ONLY Q�� <br /> R ��, City of Orono Date Received:� .�- (�Permit# � �o U <br /> AP �-���� P O Box 66 <br /> 2750 Kelley Parkway ❑In-House S C Determination Form Completed <br /> � .�y� Crystal Bay,MN 55323 <br /> (i�1 � , (952)249-4600/Fax(952)249-4616 Approved By(If Required): � <br /> �, ��.,.,�,,.�` <br /> CITY OF ORONO-SEWER&WATER/GENERAL PERMIT �U �� p�.?j� <br /> (*Note:Some permits may require approval by the Building Oflicial and/or Public Works Department*) ,L �" <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoalication is received) ��/y�� <br /> �/�. <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 /> �Residential (May Require Approval) ❑Commercial(Approval Required) <br /> �New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑Disconnect <br /> � ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: `� ��� ��"" �'� `�'' ""'-' ��'�-� <br /> Owner.T�`���� ��' '`�� Mailing Address: I ,�f W�� �j� <br /> City: 1,�.��1,���� Zip: J J��) <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> � <br /> Contractor: ���-��Sl� ���-�'"Conta Pe�� �LL,�� �`� <br /> c • : <br /> Address: ����� ����tate License#: <br /> City: �� � Zip����Expiration Date: <br /> Phone: `��,/J�� "���� '�`7-r�'� Alternate Phone: <br />