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e <br /> FOR CITY USE ONLY. <br /> oCity of Orono Date Received ; .Permit# <br /> D a Q P.O.Box 66 <br /> •, 2750 Kelley Parkway ❑In-Hou se SAC Determination Form Completed. . <br /> y , Crystal Bay,MN 55323 <br /> (952)249-4600 Approved'By(If Required): <br /> s <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERAUT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- May be subject to further review and may not be issued when the anniication 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 pemut 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 PER-NIIT <br /> (Check All That A 'ply) <br /> ❑Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑New Connection ❑Additional Connection ❑Re-Connection ❑Repairs Disconnect <br /> Job Site/Owrier Information: <br /> Site Address: 41,731 V6 e e /'1 v <br /> Owner: s c�dy Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: Contact Person: �/ ✓dam ,��� <br /> Address: �3 3 n���r//L �/14 State License#: 2, 6 <br /> Z 7 I <br /> City: Cr�J�u' l AfA. Zip: Expiration Date: Z l <br /> Phone: 76 -Y`�- 3s"--") Alternate Phone: Cl 2.- Z° 1 33 -3 <br />