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05/23/17 07:39 OLSONCONSTRUCTION 9524485289 p.02 <br /> FOR =T'fY�iJSE ONLY <br /> ��3M�, City of Orono I7atei2eceived: ����'�/'�ernut!! ,��- .s.s 7 <br /> 1.0.I3os 65 �-�T <br /> � � 2750 Kelley Pazk�vay ❑In-Iiouse SAC 37etermin�q(on Form Completed <br /> � . � Crystnl Bay,MN 55323 �Y � <br /> ',�.�''� t '� (952)249-460(?J l�ax(952)249-4G1G Appraved By(If Required): �O�� <br /> . A.F511���" ' <br /> CITY QF ORONO—SEWER&WATER/GENERAL PERMIT <br /> ("Note:Some permits uuty rcc�airc approval by the E3tulding Ufficinl an�2lor Public Works Dt,�ariment") <br /> (ALL PERMiTS- Mav be sub�g�tg thrther review xnd mav not be jsxucxl w g�t the app,i�,t�ius received) <br /> GENERAL iNFORMATION <br /> 1. You may apply for uti(ity permits by maii or in person at the City offices. <br /> 2. Maited in applications are subject to the postage and handling fee shown befow. Permit cards will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are not valid antil you receive a permit card. <br /> 4. Work must not begrn unless the permit card is available on the job site. <br /> 5. Utility conneetion 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 NQT EXCAVATE IN ANY STREET AND DU NUT TAP ANY MAIN without express <br /> approva)of the Public Works Department. Issuance of a permit does not gant this approval. <br /> 7_ AI1 work must be done in accordance with State Cale requirements. <br /> 8. All work must be inspec#ed before it is cc�vered. Call(952}244-46(30,24+hour notice required. <br /> TYPE OF PERMIT <br /> Check All That A I <br /> �Residentia((May Require Approval) ❑Commercial(Approval i�equired) <br /> � <br /> ❑New Connection ❑Additional Connection ❑Re-Connection ❑Repairs �Discannect <br /> ❑ Water Availabiiity Connection For Future Hook-Up to Water <br /> Job Site/4wner Information: <br /> Site Address: ��� ('(�,����-�-� <br /> Owner:(Y�i C.,��(1{',_1�t�il���j�-�{�_�-�-��-Mailing Address: �•5�� (�(]�(ij���(��� <br /> City: �b,�� Zip: _ ����j�� �,....._ <br /> Home Phone: Alternate Phone: <br /> Contractor Informarion: <br /> v�sor��'�n�-� �c�� <br /> Contractor: t''�(�n ()`5'�' ��, ��Qntact Person: ��r-�.1� � , '(�� <br /> Address: ��7(�_��1�� � State License#: ��'�!tO�� �f�� �� <br /> City: �C� C /1..Q Zip:�j�;�xpiration Date: I Z.��i "� <br /> __�� <br /> Phone: ,�;�- ��-��'(�'o�� Alternate Phone: �-,�(��'��...�j'�. <br />