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, . . <br /> F�R GIT'Y USE ONLX � <br /> �,�0�� City of Orono DateR�ceived. Pertnit#��� <br /> P.O.Box 66 ' ' <br /> 2750 Kelley Parkway ❑ln-Hpuse SAC.Determination Fomt Comple#ed <br /> � . � >. � Crystal Bay,MN 55323 <br /> �e� (952)249-4600 Approued Bg(�f Required}: � <br /> � �� <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERMIT <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 auolication is receivedl <br /> GENERAL INFORMATION ' <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 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 pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Deparhnent(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 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 UF PERMIT : <br /> Check All That A 1 ) ` <br /> ❑Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> �ew 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: �5 m�1/'�'����c� �� <br /> ,� <br /> � — �/ 1 I <br /> Owner: ��1 `�rvte�t.�Pa��f Mailing Address: <br /> City: �rCsnO Zip: 5 S .3� � <br /> Home Phone: <br /> ����/�^�f%� Alternate Phone: �� ( r <br /> Contractor Information: <br /> Contractor: �G���ca h l�cG� Contact Person: �q e�.� S• <br /> Address: ���� �l S+ �Ue State License#: <br /> City: l C�� ?��8 Zip:�►�/ Expiration Date: <br /> Phone: ����SU ���� Alternate Phone: <br />