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, <br /> . . <br /> FOR CITY USE ONLY <br /> ��NO City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �, Crystal Bay,MN 55323 <br /> fF �'.�ti�\,���^ (952)249-4600/Fa�c(952)249-4616 Approved By(If Required): <br /> c.�,.� <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 PERMIT5- Mav be subiect to further review and mav not be issued when the aonlication is receiv�d) <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 permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Deparhnent(952-249-4600)for urility 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 A 1 <br /> �Residential(May Require Approvai) ❑Commercial(Approval Required) <br /> ❑New Connection ❑Addirional Connection ❑Re-Connecrion ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Informarion: <br /> Site Address: �l�-Q N'�v��c. �A^-'� V�O1'�� <br /> Owner:�`�"� ��"�-' '�-`� Mailing Address: �z-O ( b��S"t �,�� ���'d <br /> City: ���rs 1�- Zip: �5�� � <br /> Home Phone: �tZ�S�S� Y T Alternate Phone: <br /> Contractor Information: <br /> COritIdCtOT: Dusty's Drain Cleaining,[nc COritaCt POTSOII: Dustin Guinn <br /> f�C�dTCSS: PO Box 262 StStO L10EriS0#: PM065901 <br /> Ci�: St.Francis Zip:55070 EXpiTBtlOri D1t0: 12/31/16 <br /> Phone: �63-zs6-s�a� Alternate Phone: <br />