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FOR CITY USE ONLY <br /> R-U�V� City of Orono Date Received: Percnit# <br /> P.O.Box 66 <br /> ' 2750 Kelley Parkway ❑[n-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> �'.� �,��� (952)249-4600 Approved By(If Required): <br /> A!�li�)b <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 PF.RMITS- Mav be subiect to further review and mav not be issued when the application is received) <br /> GENERAL INFORMATION <br /> L 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 utility srizb 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: �.�J S ���:-`�� ;5 L,���--e. ��--��� <br /> Owner: ��K� u�„� P f C��e v���c�� Mailing Address: �J��� Ju✓���r�> �c y-' <br /> c�ty: F�y,�,��-Iti z�p: �S ���, <br /> Home Phone: 7� 7 �S 5 1- %�S�/ Alternate Phone: <br /> Contractor Information: <br /> Contractar: � ��; � %�,-,�� �, � Contact Person: ���� �X <br /> Address: �l�1U� C:;. �� � State License #: -3�jl <br /> City: �ap�Z��5 Zip:�S j`�3 Expiration Date: <br /> Phone: �S Z-`���` `���3-� Alternate Phone: ra�Z-3(�%�- �3 �f� <br />