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t@�CITY tJE t)�fi.Y <br /> City of Orono E*W R ivdd: P it <br /> P.O.Box 66 <br /> 2750 Kelley Parkway In-HuseCDateraduti on Form Completed <br /> a 1 Crystal Bay,MN 55323 <br /> 9 2 <br /> ( 5 )249-4600/Fax(952)249-4616 Approved�y((lff Requir <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERNUT <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 aoolicadon 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(952-2494600)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 PERNT <br /> Check All That <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: 37 50 NoNfoi 4 <br /> Owner:. l�f �I° Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Ctltratr.I> formeton: <br /> Contractor: Contact Person: )41 <br /> Address: ( `1 I 7 ¢h 4vt State License#: <br /> City: Ufq/L Zip:�w Expiration Date: <br /> 6 �``//AAGG <br /> Phone: 763- 2 I`v Alternate Phone: <br />