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y ,� FOR CITY USE ONLY �-� <br /> -����^.� City of Orono Date Received: �n'� "/�# � /�J <br /> P.O.Box 66 <br /> � � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> , � - Crystal Bay,MN 55323 y� � <br /> �R.� ��� (952)249-4600/Fax(952)24913616 Approved By(If Required): �1'T� �/,(/� <br /> � l <br /> CiTY OF ORONO—SEWER&WATER/GENERAL PERMIT J�/� j/S <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the application is received) <br /> GENERAL INFOR.MATION <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. Pernut 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 pertnit 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)far 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 wark 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 A l <br /> �Residential(May Require Approval) ❑Commercial(Approval Required) <br /> �,New Connection ❑ Additiona(Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: � 6 �T�\Q,������� '(Z'C� <br /> Owner: C4��,�,���.('\�:�_r�`�v.\ Mailing Address: ���)� i„��.�,�,��ie�`n c� <br /> City: i a.�c n P�,,.; r:� Zip: .�� 3 y� <br /> Home Phone: `�S�-�y�'1 f. ��, Alternate Phone: <br /> �� <br /> Contractor Information: <br /> Contractor: C:c��� ��,,� ��;���' Contact Person: �;�,\�j�;� <br /> Address: ��l f,ZJcs::\ .�t�..,�� State License#: �513�.�- M�. <br /> City: ��}cx1-���,�p_ Zip:� Expiration Date: ��"�\- I(� <br /> Phone: 6�a.'.��i-�o1��{ Alternate Phone: <br />