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r • • <br /> FOR CITY USE ONLY <br /> ,j-��—����r, Clty of Orono Date Received: Permit# <br /> rr � `�'' �\ P.O.Box 66 <br /> � 1,t � 2750 l:elley Parkway ❑In-House SAC Determination Form Completed <br /> �', \� � Crystal Bay,MN 55323 <br /> �'�� �-'�='� -�� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> �.,:�����; <br /> CITY OF ORONO— SEWER& WATER/GENERAL PERMIT <br /> (*hote:Soine permiu may require approval by the Building Official andlor Public Works Department*) <br /> (ALL PERMITS- Ma��be subiect to further review and ma��not be issued when the application is received) <br /> GENERAL 1NFORMATION <br /> 1. You may apply far 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 unfil 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 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 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 /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: ���'��d'���Ii��'� �l�!s1!"C� <br /> Owner:%�� ��i���� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: �I,1�S�/vl�j"`('_.C�(,'j���Contact Person: �,►'�' <br /> Address: ��J7�� 117��]�. State License#: <br /> City: � �%����Zip��� Expiration Date: <br /> Phone: �p� ��� ( �/� Alternate Phone: <br />