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� , .. <br /> -� '� FOR CITY USE ONLY <br /> �����^/� City of Orono Date Received: Permit# <br /> � '. P.O. Box 66 <br /> i , ` 2750 Kelley Pazkway ❑In-House SAC Determination Form Completed <br /> ��, , � � Crystal Bay,MN 55323 <br /> ` �.� . l��:- (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> hf:5l.�ti� � <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 aonlication is received) <br /> GENERAL 1NFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Maited 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 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 /> 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: 3��(� JV a VtL�'Y� CCu'1� <br /> Owner: Mailing Address: <br /> City: �(�D��� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> � > / r /� ` <br /> Contractor: � ( �j Q,S (,�S< l ontact Person: /� Gl'�1��'C``� <br /> r,� <br /> Address: II D�� C- �• �b,�G State License #: <br /> City: �� INh Zip:�s��Expiration Date: <br /> Phone: (/�a• ���• J��7 Alternate Phone: _!S�� 9sS. �S���, <br />