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a <br /> FOR CrrY USE'ONLY, <br /> O�O�O City of Orono Date Received : Permit# <br /> P.O.Box 66 <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completed.. <br /> Crystal Bay,MN 55323 <br /> .ago (952)249-4600 Approved By(If Required): <br /> e <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- May be subiect to further review and may not be issued when the application 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 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 PERTT <br /> (Check All That APPIy) <br /> ❑Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑New Connection ❑Additional Connection ❑Re-Connection ❑Repairs KDisconnect <br /> Job Site/Owner Information: <br /> Site Address: `7 7 /Vu 0 v <br /> Owner:,/D-&, �� C Z1,✓ Mailing Address: <br /> City: Zip: <br /> Horne Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: lee,,-)Yr Contact Person: <br /> Address: State License#: t2 2 6 3 <br /> City: ����� / Zip: ' Expiration Date: / 2- -3 /— C) -7 <br /> Phone: ,�s - �1- 3 s'�� Alternate Phone: �j 2 0 3 <br />