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- FOR CITY:USE ONLY <br /> ��� City Of Orono Dafe Received: Permit# ' <br /> P.O.Box 66 � <br /> �'� � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> � � t� Crystal Bay,MN 55323 <br /> �a��o,j�y�e' (952)249-4600 Approved By(If Required): <br /> CITY OF ORONO-SEWER&WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building O�cial and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the annlication is received) <br /> GENERAL INFORIVIATION _ <br /> 1. You may apply for utility pernuts by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut 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 pernut card is available on the job site. <br /> 5. Urility connection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Depariment(952-249-4600)for utility stub as-built locarions. <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 dus approval. <br /> 7. Al!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 /> (Gheck Al1 That Ap''ly) ; , <br /> �Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑ New Connecrion �Additional Connecrion ❑Re-Connectiou ❑Repairs ❑Disconnect <br /> Job Site/Owner Information: <br /> Site Address: �a�0 !�o �-�.Sl�r e �r►,� �r 0�p. <br /> Owner: o v� ` Mailing Address: �a�O 1'�✓�'�"jlti-�r1,�e �r�� <br /> City: �1�cX117 Zip: S�'3� � <br /> Home Phone: �o't''����a�( Alternate Phone: <br /> Contractor Information: <br /> Contractor: `��/g �-� �co�ct Person: '�Y <br /> � <br /> Address: �� �, �,��1`�' State License#: ���� <br /> City: ��u Zip:553��Expiration Date: f D� <br /> ��� � <br /> Phone: �'�- ���+112Q� Alternate Phone: C�P GI �a����o� <br />