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� . <br /> FOR CITY LJSE ONLY <br /> �,¢� City of Orono Date Received: Permit# <br /> � P.O.Box 66 <br /> �l��y;;, �� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �1'�.''/�r �� Crystal Bay,MN i5323 <br /> �� ��+� <br /> ����,�,������G`� (952)249-4600 Approved By(If Required): <br /> �,r�oe.,� <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 not be issued when the aoplication 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 l ) <br /> �Residential(May Require Approval) � Commercial (Approval Required) <br /> �New Connection ❑ Additional Connection � Re-Connection �Repairs ❑ Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: (� 'e. f� ? ��'� <br /> _-I -� <br /> Owner: 1 r'i Y1�•i �C.,��1 D �J Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: � I� 7��i ��Gt 0� <br /> Contractor Infonnation: <br /> Contractor: '�.-���� � t' I��'1 � Contact Person: �^Gi►'1 C e <br /> Address: � `{ �0 C�-� Q J �� State License #: � � � � <br /> City: l. '► '�`^ L�'�`S��Zip��J Expiration Date: ���� � �� <br /> Phone: I S a � 7�-�-� I �O Alternate Phone: � �� �'� �- � 1-� v <br />