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fog cry usE ONLY <br /> areONO City of Orono Date Received: 1-9-j`j Permit#020/rf- 24a <br /> P.O.Box 66 <br /> f2750 Kelley Parkway D In-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> 11 cc,, (952)249-4600/Fax(952)249-4616 Approved By(11Required): <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 annlicatton 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 0 Additional Connection ❑Re-Connection 0 Repairs 11 Disconnect <br /> 0 Water Availability Connection For Future Hook-Up to Wa <br /> Job Site/Owner Information: <br /> Site Address: ,`3e;) (' /V V'�,� �^ (-) �gv/I, <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: (/4 L X $ J XG Contact Person: ( uCA ideA <br /> Address: 760 id 9 6 State License#: 0 <br /> City: AQ-5St- Zip: 3(7 Expiration Date: - i g <br /> Phone: 96—Z a?f z ^ a��� Alternate Phone: �6a 0( ,? g7y <br />