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. .- ��f� <br /> FOR CITY USE ONLY <br /> ,��� City of Orono Date Reccived: Permit# <br /> O£ O P•O.Box 66 <br /> <1 <br /> �;,, 2750 Kelley Parkway ❑In-House SAC Determination Form Completed �'�I C <br /> i'���'�� Crystal Bay,MN 55323 � <br /> � � ����'� � �-� <br /> �,��fi��`o (952)249-4600 Approved By([f Required): <br /> sesa$ <br /> CITY OF ORONO -SEWER& WATER/ GENERAL PERMIT � D fo� " <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) � ��-�O <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the an�lication is received) <br /> ���Z�f j Z <br /> GENERAL 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 card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed contractars 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 Apply) <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> , �New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> ❑ Water Availability Connecrion For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: ��� � �(� /� �'� � <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> �- <br /> I Contractor Information: <br /> Contractor: V�-�"S��"i" �`� S�c�J Contact Person: �(���✓t �LG-'' � <br /> ,- <br /> Address: �,��(�( �_ /2��� (5� State License#: <br /> City� ����� Zip:S�E��Expiration Date: <br /> Phone: � J`�-Z-`-�7.�� u�� Alternate Phone: U�-�- 7`l�' S �7�� <br />