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� ,..,�,,.,.� ._ _ <br /> F�R, , USE ONLY / <br /> ��� City of Orono �Da�Reoeiv�ed.� em��t#����.""_d� 7�°�' <br /> P.O.Box 66 `��'�' <br /> �" � 2750 Kelley Parkway 0 Sn-Fiouse SAC Determination Form.Completed <br /> � � ;, � Crystal Bay,MN 55323 <br /> t��o4` <br /> (952)249-4600 Approveti By('IfRequirec3): ` <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERMIT <br /> (*Note:Some permiu 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 aoalication is received) <br /> GENERAL,3i�1Ft�1ZM�TT�N'; <br /> 1. You may apply for urility pernuts by mail or in person at the City offices. <br /> 2. Mailed in applicarions 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. Urility 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 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 /> TZ'PE�F�'��'IT: <br /> (Ghec`k�,11�iat:A �?1' j ` <br /> ❑Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> � New Connection ❑Addirional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> � Water Availability Connecrion For Future Hook-Up to Water <br /> J�ib�'�1�e��vvrier Iriformation. <br /> Site Address: y Mv�'���.��,� R.D <br /> Owner: "3QS�`ce� Q�Pats/1 Mailing Address: ��/���\w�nt� <br /> City: Orc7r�L� Zip: <br /> Home Phone: �S�l.-��(�-��7�. Alternate Phone: <br /> Con�r•actor=��orma:tion: � ', <br /> Contractor: C T�:� 5`..�t' c W:��l�e� Contact Person: Q:�\ c�.�`•��_ <br /> , <br /> Address: ���1 �,�i� ��� State License#: �7��;`�J�1R <br /> City: �:4ec}�„� Zip:�3� Expiration Date: �'�-3i-04 <br /> Phone: q��y SS- �S`c3�3 Alternate Phone: �\�- 508��`��`�1 <br />