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r <br /> FOR CITY USE ONLY 4'� a <br /> -.-',10'0� City of Orono Date Received: . I i irk.Permit# <br /> ^ O P.O.Box 66 <br /> 2750.Kelley Parkway ❑In-House SAC Determination Form Completed <br /> a, <br /> "air <br /> tt Crystal Bay,MN 55323 <br /> *t,: $yo (952)249-4600 Approved By(If Required): <br /> �aas <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 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 /> Tew Connection ❑Additional Connection ❑Re-Connection ❑ Repairs ❑Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: )OOO Oka 1.0tr Ir\cx L. P o c o <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ell 4. Contact Person: ie 1 1\ rt -L.oie <br /> Address: 'a 60 Got Nv.,,,v.6.w t State License#: So ciq f/14 <br /> City: SI-.Lokk'•s P.A. Zip:SSLao Expiration Date: 0 - T I - 0 ' <br /> Phone: Gs4-9?q- G 7b7 Alternate Phone: 9 5. -9,x9-6-76-2 c,,,,f 0 <br />