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FOR MY USE ONLY <br /> City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> r` c (952)249-4600/Fax(952)249-4616 Approved By(if Required): <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 PERMTTS- May be subject 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 PERMIT <br /> Check All That Apply) <br /> ❑Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ,VNew Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: I / <br /> Site Address: �1� C l' Tom( <br /> Owner:`f I'4 4'0 5,40015 Mailing Address: <br /> City: d r-On D Zip: 5 �� <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ���� � � t,� Contact Person: ✓J <br /> Address: jI �Q� `! State License#: <br /> City: G �/���' Zip:53)W Expiration Date: <br /> Phone: lb-^ o'-V1 P Alternate Phone: <br />