Laserfiche WebLink
s � <br /> FOR CITY LiSE ONLY � � <br /> .1����� City of Orono Date Received:� Pemtit# a��� " � � <br /> G r.o.soX 66 -I�-�{`�-__ <br /> , ' 2750 Kelley Parla���y ❑In-House SAC Deteimination Form Completed <br /> �, i a = Crystal Bay.MN 5533� <br /> ` ' ` (952)249-4600 Approved By(If Required): <br /> '-r!�•, <br /> tir. <br /> CITY OF ORONO—SEWER & WATER/GENERAL PERMIT <br /> (*1�ote:Some perniits may require appro�al by the Building Official and/or Public Works Department*) <br /> (ALL PERDITTS- :1fa��be subiect to further reviee�and mav not be issued when the aanlication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pennits by mail or in person at the City ot��ices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pennit 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. Utility connec[ion 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 STIiEET 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 notiee 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: � I`7 �,i' � lll�hV�ti):.i�� ���� <br /> Owner: SCi.'� �J=�U11 P��� Mailing Address: �1�i� 1k1ti Y\.T���:-� �C{. <br /> Clty: �'1�(J'.`1iJ Zlp: �J,S,Z _� <br /> Home Phone: ���a' ��� "���� Alternate Phone: <br /> Contractor Information: <br /> Contractor: ��?�Y��a � 1 tnL. Contact Person: `- �� ��� <br /> Address: 1��'�"2:1 J u1nY►.��'1 State License #: ��.'-��� l�J55 <br /> ,/�1�y'yU;�(���� `�C. >`>j 1�l <br /> City: ��j�� ' a Zip:� Expiration Date: � 3� �� <br /> Phone: �1��- ����� ' Cr3�lU� Alternate Phone: �;J��I- Z`�� ����«'� <br />