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••► <br /> t � <br /> FOR iTY USE ONL,Y <br /> ��-�� City of Orono Date Receivec:' Z Parmit# ����� �� <br /> � P.O.Box 66 ��; f <br /> - � � ?750 Keiley Parkway �Ir.-House SAC 13etennination Form�mpleted L 1�,�,�` <br /> tt. <br /> � a _,F Crystajl Bay,MN 55323 � N--E--�- .� ' <br /> , ��q�`1��% (952)244-46Q0/Fax(952}2�34-4616 Approved By(If Required): <br /> C11 Y OF ORONO—SEWER& WATER/GENERAL PERMiT <br /> (*Note:Su�rie pemiits may reyoire approval by the Buiiding Of,iciaf and/or Pub!ic Works Depa;tment") <br /> {AI.L PERMI'TS- �lav be subiect to turther review and ma�not be issued when the aonlicaiion is received) <br /> ; GENERAL INFORMATION _ <br /> 1. You may apply for utility permits by mail or in person at the Ciry offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown belaw. Permit cards will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are not valid unEil you receive a perrnit card. <br /> 4. Wark must not begin�mless thz permit�;ard is availabla on the job site. <br /> 5. Utility connection pennits may be issued to licensed contractors only. <br /> 6. Coniact the Public Works Department(952-249-4600)for utility stub as-bui{t locations. <br /> DO NOT EXCAVATE IN ANY STREET'AND DO NOT TAP ANY VIAIN withaut express <br /> approval of the Public Works Dep�rtment. Issuance of a permit does not grant this approval. <br /> 7. AIl work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it i�covered. Call(952)249-46Q0,24+hour notice required. <br /> I TYPE OF FER14iIT � <br /> � {Check All That Apply) <br /> [�Residentia!(May Require Approvalj ❑Commer�ial(Approval Required) <br /> ❑ New Connection ❑Additional Connection ❑Re-Connection �Repairs �]Disconnect <br /> ❑ Water Availability Connection For Funire Hook-Up to Water <br /> � Job Site/Owner Information: , <br /> Site Address: Z�l`�5 NOr� S�1.DYe- �r1 VL. <br /> Owner:�� S�-�G%H hQ�G� MailingAddre,ss: ZZloS /�•S�'IOVe 1�✓ <br /> c��V: � �o►�o z�p: 5539 I <br /> Home Phone: to l Z �02 31 dS Aiternate Phone: <br /> � Contractor Intormation: � <br /> Contractor: �)SS�e wav� Co 1 n� Contact Person: �l�LC..1.1 �it�Q.B�'Pr�,1 <br /> Address: �l�3b [�t,VriDr►��'VCN� State License#: <br /> City: �Y10� Zip:ss3�}/ Expiration Date: <br /> Phone: 7(�� �L�{ q 03D Alternate Phone: (Ql Z 3(04 �e 8y/ <br />