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FOIt C1TY USE ON[�Y. <br /> ,��� City of Orono Date Received: `l'2i-U� Permit# ��ZU <br /> P.O.Box 66 <br /> ��„.,;,,, O 27�0 Kelley Park�vay ❑Tn-House SAC Determination Form Completed <br /> � ��jS��;z;' y Crystal Bay,MN 55323 <br /> �l'T��,��.�o (952)249-4600 Approved By(If Required)� <br /> '�$exo$ <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some pennits 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 ann��cation is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pernuts by mail or in person at the City offices. <br /> 2. Mailed ui applications are subject to the postage and handling fee shown below. Pernut 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 peinut 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 Apply) <br /> ❑ Residential(May Require Approval) �] Commercial(Approval Required) <br /> ❑ New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> Job Site/ Owner Information: <br /> � <br /> Site Address: � <br /> Owner: �� ,�� �'/J Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: i <br /> Contractor:�/�� W Contact Person: '��� <br /> Address: 7 � (� Gt��� �� State License #: �� �� <br /> (�, <br /> Cit C��' ✓ Zi �� ��Ex iration Date: ` <br /> Y� P� P 1 � � � � � <br /> Phone: Alternate Phone: � � l C� / � (,� � � � <br />