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� , <br /> �--' FOR CITY USE ONLY <br /> ��-��O� City of Orono Date Received:��_����,,, Permit#Z (�/(r;=� ���.�— <br /> ;` `•4 P.O.Box 66 �r'� <br /> � � ; 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> ,��' Crystal Bay,MN 55323 <br /> `\`'\�1.�¢i j (952)249-4600/Fau(952)249-4616 Approved By(If Required): - <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official arid/or Public Works Departrnent*) <br /> (ALL PERMII'S- Mav be subiect to further review and mav not be issued when the aoalication is receivedl <br /> GENERAI,INFORMATION <br /> L 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. Permit 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 permit cazd 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 A i <br /> �] Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> / <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: � � � � ���-r- � � y �� '� <br /> Owner: Z J � �%-'� � Mailing Address: � <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: � �-�^ L�u v�-�-r��LL Contact Person: � f ( �L'�'`'i � <br /> Address: -�v�f S ���.-L � {�ou� �4 State License#: � 3 C���CD f �'I <br /> City: G� ��H-e-�r,'S E� Zip:s 5�Expiration Date: � Z - 3 cj _ /� <br /> Phone: ��Z - C��f`�— S 3 5 S Alternate Phone: <br />