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� • . <br /> ��'.� �ox c�t��oxc,v <br /> '��NO�� City of Orono Date ltecei�ed: t" ,� Perm�t tl �G' l� �- ��'��- <br /> ; P.O.Box 66 <br /> ; 2750 Kelley Parkway Q In-I�oase SAC Determination For�Completed <br /> ;� ,�-f Crystai Bay,MN 55323 <br /> `' � (952 249-4600/F� 952 249-4616 mved B <br /> ���,��.sHo��� ) ( ) APP Y(IfRtquircdj; <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERMIT �+�'�=��% ��s�"� <br /> ('Note:Some permits may require approval by the Building Official and/or Pubtic Works Departrnent•) <br /> (ALL PERMTI'S• M�y be,c��hi.�.�r r�t��rrh�����and mav not be issaed when Me■���;��h �� riv�dl <br /> GENE�tAI.INFORMATIOI� <br /> 1. 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 retum 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 card is available on the job site. <br /> S. 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 ezpress <br /> approval o[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 /> TY��OF PERA�T <br /> Check All That A 1 <br /> ❑Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection ❑Re-Connection ❑ Repairs �Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Jo� Si�e/Ow�er Inforr�ation: <br /> Site Address: _oZ5� D Gr9-S c�► r�'1� 1�.� <br /> Owner: �`�1[-� t-}-�q-�'t` Mailing Address: <br /> city: � ►2 0 ►vo ZIP; 5 S'3� � <br /> Home Phone: 7G3 �°�=� ('-I� Alternate Phone: <br /> Contracto.r In�orrnation: <br /> Contractor: S`�a-rJ��,.�000 ,Lt_.L ContactPerson: SV� �,v5-r-�FSca►.J <br /> Address: I S� � �},�, ST State License#: �L �q�-f�3�� <br /> Ciiy: t�J�1-`Pzrt-r+l—Zip:�lq1 Expiration Date: <br /> Phone: (o �1=�v7���?c� Alternate Phone: � la,— �J6��'�joo� <br />