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FOR CLTY U E ONLY ��7 �j� <br />� � --:.,, Date Received:�� �t# s���� (��J <br /> f��i,t'�r`���� City of Orono � <br /> � ti P.O.Box 6G [�7n-House SAC Detennination Form Complated <br /> � �� 27�0 Kelley Yarkwa}' <br /> .:�.i�� � � Crystal 13ay,MN 553�3 p, roved By(If Requiced): — <br /> `,, PP <br /> \ �r�,-^, (952)249-4600/Fax(952)249-A616 <br /> ��.�,r�.��;�,��.,' <br /> >:_._.._.- <br /> CITY OF ORONO-SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building OfFicial ancllor Public Works Department*) <br /> ALL PERMITS- Ma be sub'ect to Curther review and ma not be issued when the a lication is received) <br /> GENERAL INFORMATION - - <br /> 1. You may apply for utility permits by mail or in person at the City oftices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Nermit cards will <br /> be sent by retuin inail within 2 business days. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin uuless the permit card is available on the job site. <br /> 5. Utility connection permits n�ay be issue�i to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. <br /> DO NOT EXCAVATE lN AN�'STREET AND DO NOT TAP ANY A1A1N���ithout express <br /> approva!of the Public Works Department. Isstiiance of a permit does not grant this approval. <br /> 7. All work u�ust be done in accordance with State Code rec�uirements. <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 Appl� _ __ -- <br /> �'R�sidential(May Rec�uire Approval) ❑ <br /> Coinmercial(Approval Renuired) <br /> ❑New Connection �Wat r Ava 1 b lrty Conne,tio For�Future Hook-�Up to Water�Disconnect <br /> ❑ <br /> Job Site/Owner Information: <br /> Site Address: %f1'L�`J �L��G U �11������r <br /> '' Mailin Address: I�5��`�� ��`j � "�U�'�'` � <br /> Owner:�, //L <br /> ��ti.�L TTZ LC,��i g -�—�— <br /> City: �l��l�l/e��i'�� — Zip: — <br /> �`��/�% <br /> Home Phone: _ Alternate Phone: _ <br /> Contractor Information: <br /> Contractor: �(,Ll��l� ��r���1T"1/z� <br /> Contact Person: `�7��1/(_- /�GG��/U� <br /> , _. <br /> Address: ���1�7r� C�-� I�L'� Z� State License #: �/� �����— <br /> � Zip:=�.�'(.� Expiration Date: /�/`� <br /> City: � <br /> Phone: <br /> ��Z � "� �3 J� � Alternate Phone: ���Z^ ��� -��^�-� <br />