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1 . , ti <br /> �0� � City of Orono Date ITaxi�eed. per�ut#Y - a-I <br /> � � P.O.Box 66 <br /> ; <br /> 2750 Kelley Parkway �In-I�onse SAC Det�rmination Fa�m Completed <br /> � ,�� Crystal Bay,MN 55323 <br /> ��t�'Y[SH�¢�L, �952)249-4G00/Fax(952)249-4616 Approved By.(�'Rtqu�ed�: . . <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERNIIT <br /> (*Note:Some permits may require approval by tlu Building O�cial and/or Public Works Departrnent') <br /> (�.�,PE�$- �'j1V bt lUb�lC1�O fll��r/!VIl�V!�d d1�V�Ot�1t iasnal ah�n fh��nnlin'Hnn ia.,....i....11 <br /> GEI'�tE�tAi,INFORMATIOl� <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 cazds 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 card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> 6. Comact 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 of the Public Works Department. Issuance ofa pernut 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 PER1�.tT <br /> Check�11 That A <br /> �Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑New Connection ❑Addirional Connection �Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up W Water <br /> Job Site/C)vvner inFo.�ation: <br /> Site Address: �`� 3 c7 ��zC P\'_,.� (>� <br /> Owner:�'a,�,�`�e-- Te�(-'A R Mailing Address: l��LLS`-oce�„ p( <br /> City: C1 �1��r, Zip: SS'�°�\ <br /> Home Phone: Alternate Phone: �,`a.` �(,9 � ��RO <br /> Contractor In�ormation; <br /> Contractor: C,e��� 54,��eT�,,,�k( ContactPerson: R`,�� c.o��_,� <br /> Address: �(,K c��.:�- �� State License#: �'7 3 ay -M+tZ. <br /> City: wn,.1-Q«,x�„� Zip:S�3�� Expiration Date: \'a..-3�� �� <br /> Phone: ���.'S�`b-�°11`� Alternate Phone: <br /> ,, \ <br /> . -� <br />