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z � <br /> � ���� <br /> �'�� S�vVI.LLI�'] <br /> , <br /> F C Y USE ONLY b ��a a <br /> City of Orono Date Receive Z Permit# � �a— � <br /> �¢��� P.O.Box 66 <br /> � � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> 9 �,y�;• Crystal Bay,MN 55323 <br /> ��e ,�_��.��� (952)249-4600 Approved By(If Required): <br /> �'�er�xv�*': <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 auolication is receivedl <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. Perrr►it cards will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are not valid ,intil you receive a permit card. <br /> 4. VVork must not begin unless the permit card is avai[aole 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: 3�U� � ���/ �� ���� � <br /> Owner: ` �b � � c-� �-c'_✓ __ Mailing Address: ��C� I v"�j (���.�C�, <br /> City: (�Y C�n0 Zip: � `� ��1 � <br /> Home Phone: �' I Z - (v 7 L � C:�`j���; Alternate Phone: ��I Z - _3(n � �-�, 7`1 � <br /> Contractor Information: <br /> Contractor: ,��S-��:c.�`C�u � (�U � ��_� Contact Person: ���t���S � '�t,c..`G-�� <br /> Address: � �CG��I `-Gt vti1G✓I�`��V'�N�State License#: <br /> Ciry: �, 1(� J�v Zip:.`��3�I� Expiration Date: <br /> Phone: 1 Lv.�-4Zy-��t U��� Alternate Phone: (v l Z-���� ��'�`t I <br />