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. . . . . ,.,:..sww,, .�..,.... .F..... . . .,. y�:a.�..,,.z,.,._.„ ..,w,.. . . .. .... .,.... . .. .... :,,;,,.... . .. .. .. <br /> � "' FOR CITY USE ONLY <br /> ;-��n/�/� City of Orono Date Received: Pern�it# �/,3-� �7 3 <br /> P O. Box 66 <br /> /l� 27�0 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �� i � � Crystal E3ay,MN 55323 <br /> � � (952)249-4600/Fax(952)249-4616 Approved By(IF Required): <br /> �` `. <br /> CITY OF ORONO —SEWER & WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Buildin'Official and/or Public Works Departmen[*) <br /> (.ALL PER�IITS- Nlav be subiect to further review and mav not be issued when the apnlication is received) <br /> GENERAL 1NFORMATION <br /> 1. You may apply for utility pennits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the posta�e 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 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 Apply) <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 /> Job Site /Owner Information: <br /> Site Address: � `� Z� /�'� `^"��� �f� <br /> Owner: L"""'SDJri.Q� Mailing Address: S S D z S �-� �-,n� .� <br /> City: �T� G��✓�� Zlp: �� 3�� <br /> Home Phone: 16� � �5 �'��� Alternate Phone: <br /> Contractor Information: <br /> � � �G�,w�,-� Vr����r�✓K k. (L SG�.w<< l� <br /> Contractor: Contact Person: �` <br /> Address: ��'��� �� � t� '�� State License #: � � � ���� �'� <br /> City: `�G °�' Zip: 5 S�G� Expiration Date: Z� ��� <br /> Phone: �b3 '��1 � L�j Z Alternate Phone: �i�`^^�- <br />