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�()R CITY rtl�,OT�LY <br /> ���0�� City Of Orono Date Recei�ea: Per�it# <br /> ; P.O.Box 66 <br /> � f 2750 Ke(Icy Parkway �7n-�o�se SAC Dectrminatioa Form Complcted <br /> �, ,�� Crystal Bay,MN 55323 <br /> \�[sH oQ'kL` (952)249-4600/Fa�c(952)249-4616 Approved BY(IYRequirod): <br /> CITY OF ORONO—SEWER&WATER/GENERAL pERMIT <br /> (`Note:Some peamits may require apProval by the Building Officiffi and/or Public Works Departrnprt s) <br /> (ALL PERMITS- 11iav be snbi tn fn'fh�r ervi�!pa maV�Ot I/2 i"s.ued��hen the aoo;;� tinn ix h�w� <br /> GfiI�TE�tAL INFORMATIOI� <br /> 1. You may apply for utility permits by maii 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 rehun mail within 2 business days. <br /> 3. Permits are not valid until yoa receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Urility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600j for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without eapress <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,Z4+t�our notice required. <br /> TY�E OF PER.�T <br /> Check All That A i, . <br /> ❑Residential(May Require Approval) ❑ Commercial{Approval Required) <br /> �New Connection ❑Additional Connection ❑Re-Connection ❑Re airs <br /> P ❑Disconnect <br /> ❑ Water Availability Connecrion For Future Hook-Up to Water <br /> Jo� Si�e/Owm�r Info�ation: /`�, i<� C �w�-„s��:, (-�''�c S (` �� <br /> S��-1 yP8 <br /> Site Address: �� �� �d Q f th Sh�;2 ,D�. <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor In;formation: <br /> Contractor: Sc �z:�z �" �,o..�p. Contact Person: _�,-�� <br /> Address: <br /> �� ��� �5 �� a"t �'r State License#: <br /> City: C�r��r��n Zip: 5S3yo Expiration Date: <br /> Phone: ,'r6 �t? 1�� � 7y��� <br /> � � Alternate Phone: <br />