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FOR CITY USE ONLY <br /> ���N� City of Orono Datc Rcceivcd: i<����f'(�-Pcnnit t# 7�' (S -�'! �–j <br /> P.O.Box 6G <br /> 1 2750 Kcllcy Parkway ❑In-House SAC Detennination Form Completed <br /> Crystal Bay,MN 55323 <br /> '..� �,�� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> hr��ji�h <br /> CITY OF ORONO— SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Somc pcnnits may rcquirc approval by the Building Official and/or Public�Vorks Dcpartmcnt*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the anplication is received) <br /> GENERAL INFORMATION <br /> I. 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. Pern�it 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 /> [�f Residential (May Require Approval) ❑ Coinmercial(Approval Required) <br /> �New Connection ❑Additional Connection ❑ Re-Connection ❑ Repairs ❑Disconnect <br /> ❑ Water Availability Coimection For Future Hook-Up to Water <br /> Job Site/ Owner Information: <br /> SiteAddress: '� 3� ,���1��G�L w�Iirr= <br /> Owner:,U�l�'l�IZ�� /���'+=���-�]k►/� Mailing Address: %%�''� f�;�'�7a��il�;t� L_a��=���C.� <br /> City: �.fL!i'-�v�i�� �✓j Zip: � � `=i% <br /> Home Phone: Alternate Phone: <br /> Contractar Information: <br /> Contractor: '�I,C�iv�� i�<��i��a>7i�r �--,1:ii.c'. Contact Person: �J`�:.��vt I�L�_,�/U ��. <br /> Address: �?`�7�� ���L�,L,r�/ j4;�'��;(�%/ State License #: ��,���G �,;y�L�_ <br /> City: 1�-JG�'L;�Z Zip:;�;�;-���� Expiration Date: <br /> Phone: �GI�G� 1.55� :�%/Z- Alternate Phone: ((GIZJ LO�S -�/3c:i.� <br />