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• '• <br /> �D1i CPi`]'�USE ONLY <br /> �„�(��O City of Orono Date Received; • Pemcif# <br /> P.O.Box 66 <br /> 2750 Kelley Pazkway ❑In-�Iouse SAC Deterraination F�rrm-Compteted�� <br /> � ' � Crystal Bay,MN 55323 � ' '' '; <br /> � (952)249-4600 AppYo�ed By(�fRequired): <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 Aunlication is received) <br /> GENERAZ;INF+L�I�IVIATI�� ` <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 perrttit 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'PER1�fIT <br /> : Check��1'That� 1 <br /> �,Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ��ew Connection ❑Additional Connection �Re-Connection �Repairs ❑Disconnect <br /> !/ <br /> �ob�Sitel�OvvnerIz�formation; �, � � <br /> Site Address: �J �� /v�n-�� S �alze �� <br /> Owner: Mailing Address: <br /> City: Zip; <br /> Home Phone: Alternate Phone: <br /> C�ritractor Inforrnatiori: <br /> � <br /> Contractor: � S� �����7 Contact Per n• C��SS <br /> s� . <br /> Address: ���� Z-vq-t�'�� �`� State License#: �� <br /> City: d�� Zip: J3�`" Expiration Date: <br /> Phone: 7�3-`�Z`� �7��7� Alternate Phone: (Q!Z�3��5��� <br />