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FOR CITY USE ONLY <br /> ¢�� City of Orono Date Received: Permit# <br /> �' P.O.Box 66 <br /> �,,. �``, 2750 Kelley Pazkway ❑In-House SAC Determination Form Completed <br /> ��:+'''� ; Crystal Bay,MN 55323 <br /> �+�> `c, (952)249-4600 Approved By(If Required): <br /> \ �O� <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 anolication is received) <br /> GENERAL INFORMATION <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 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 utiliry 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 1 ) <br /> �Residential(May Require Approval) ❑Commercial(Approval Required) <br /> � New Connection ❑Additional Connection �Re-Connection � Repairs �Disconnect <br /> Job Site/Owner Information: <br /> Site Address: 3�� /����� ��>�� ��'> <br /> Owner: !7�/ dof'�t , Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: -t�,S, ��l�Ge��4/�7 �'o Contact Person: �us5 �►�L�Fi�czlL <br /> Address: ���`� L�-��c-��`� State License#: �� <br /> i <br /> City: �t9U�� z�pa �3�/ Expiration Date: <br /> Phone: ��3�`lZY- �r��a Alternate Phone: ��l Z� 3�(�•� .5�`6��j. <br />