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� ' <br /> • . � , <br />� � � <br /> • FOR CITY,USE ONLY� <br /> ,��� City of Orono Date Received Permit# <br /> O P.O.Box 6G , <br /> ���,i 2750 Kelley Parkway ❑In House SAC Determination Form Completed <br /> a� ���.� � Crystal Bay,MN 55323 <br /> ��� �i;�o�a (452)249-4G00 Approved By(If Required): <br /> ��R08 <br /> CIT�' OF ORONO—S�WER&WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Offcial and/or Public Works Department*) <br /> (ALL PERMITS- Niav be subiect to further review and mav not be issued when thc aonlicntion is received) <br /> GENERAL INFORivIATION ' <br /> 1. You may apply for utility pennits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will <br /> be sent by reftuzi mail within 2 business days. <br /> 3. Permits are not valid until you receive a pernut card. . <br /> 4. Work must not begin unless the pernut card is available ou the job site. <br /> 5. Utility comiection pernuts may be issued to licensed coniractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for urility shib 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 inust be iiispected before it is covered. Call(952)249-4600,24+hour notice required. <br /> TYPE QF PERMZT' ,. <br /> (Clieck All That A ' "ly) <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: l d�� <br /> Owner. ' iling Address: �'� �• �"��� <br /> City: �� ;� Zip: <br /> Honne Phone��z �{ 7� �4 �jr Alternate Phone: G �Z - G Lf I l/L- <br /> Contractor Infvrmation: � <br /> Contracto � ,.�c ntact Person: �G-LG�� � <br /> ����/.'�-�t � �`��.� <br /> Address: �12C� `�/��rn �- State License#: � � � <br /> City: �� �2-� Zip:�i�7�xpiration Date: 1� ' � f^ �� <br /> Phone: 7�' /�Gf �� �G�j `� Alternate Phone: G� �Z cI � �'/ `4j�' <br />