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FOR CITY USE ONLY <br /> ,��,�` City of Orono Date Received: Permit# <br /> O `rO P•O.Box 66 <br /> �; 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> a '� ?,. �t. p, Crystal Bay,MN 55323 <br /> �'t'��go�Oe (952)249-4600 Approved By(If Required): <br /> 4 <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 a�plication is received) <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. 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 pemut 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 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 pemrit 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: c�f; ./V� y(`��{� w,��� �� <br /> Owner: �C'_��_��{;U : � Mailing Address: o�D !►'� �'r-�Ic� ;�;r,f,�l 4�t� <br /> City: d�0 I� �,a Zip: <br /> Home Phone: q S�.��I 7 3 7°13 7 Alternate Phone: <br /> Contractor'Information: <br /> Contractor. ���;r� ��ui���, �,.,«le< Contact Person: �`I,l ' ,o,�;,� <br /> Address: �(�`-� �;��c�: � ,��..� State License #: ��)aay'/�'l 1� <br /> City: �,��,,�Q('�� Zip:�3�, Expiration Date: �o� � � 1— � l� <br /> Phone: �I Sa-`�SS"(5 � Alternate Phone: V �a " �p� "'���7C.# <br />