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� �. <br /> -- t FO CITY U � ONLY <br /> j.-,���`�y C1Yy of Orono Date Receive mut# �/ <br /> 1` � �j� P.O.Box 66 <br /> + �� '' 2750 Kelley Parkway ❑In-House SAC Determ nation Form Completed <br /> ���\E '� •nl'' Crystal Bay,MN 55323 <br /> � � '�'� �� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> � ,;, <br /> � <br /> CITY OF ORONO- SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permiu may require approval by the Building Official and/or Public N%orks Department*) <br /> (ALL PERMITS- Ma��be subiect to further revien and mav not be issued when the application is received) <br /> GENERAL 1NFORMATION <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 unril 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 A ly) <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 Informa�ion: <br /> , ._ -' ' , . <br /> Site Address: ` � ��...� ..: �-f��� �;��L 2`� �. <br /> � <br /> Owner:� ���� � Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> _.�--' � .../;�r ' <br /> Contractor: � � ��-� l.� � � ��� Contact Person: <br /> ,- � � ., � <br /> Address: � ;� S �� ��- � e License#: <br /> Ci �. ' �Uv� Zi � ��-y�C�,xpiration Date: <br /> tY: p: <br /> / , <br /> Phon�,� � � ��- �( � � ��� Alternate Phone: <br />