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FOR CrrX USEONLY ; <br /> /�g01�Td City of Orono .Date Received: PCrmitW <br /> ( P.O.Box 66 <br /> 2750 Kelley Parkway ©ln'-House SAC Determination Form Completed <br /> y Crystal Bay,MN 55323 <br /> (952)2494600 Approved By(if Required): <br /> garsxoR� <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 aoolication 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 PERMIT <br /> (Check All That Apply) <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/Omer Information: <br /> Site Address: L(73 N 6r` k sht1c <br /> Owner:CO �S'b y 6&5 fyYv 4JV7v_�ailing Address: 2 !P todt�:;c sr— <br /> City: Zip: 56331 <br /> Home Phone: Alternate Phone: 0 a 0-75 Cl ;)-L40 <br /> Contractor Information: <br /> Contractor: ✓'D �I w Contact Person: <br /> Address: 775 76 ul`1 �� State License#: Pfy\ © �p 0 (O <br /> City: 4AAMt Zip: �ikpiration Date: <br /> Phone: �7�3 - 4?k-67 12 - �Alternate Phone: ^l.--2S <br />