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r * <br /> �— daQR rl 'USE ONLY <br /> ( -Ok vCity of Orono <br /> , ate erexved? Perrntt# <br /> P.O.Box 66 <br /> 2750 Kelley Parkway ©in House SA Deterimnation Form Completed <br /> " Crystal Bay,MN 55323 <br /> .1/4,C7 (952)249-4600 Approved ly(If Bequiratl) <: <br /> �ktstto� <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 /> .GENE ORMA`=t'ION <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 /> T5 'EO 'EIT <br /> (Che At App1' <br /> Re •.ential(May Require Approval) ❑ Commercial(Approval Required) <br /> 'd New Connection ❑ Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Site Address: 2337 04..750‘/W <br /> Owner: it /#741631,16 Mailing Address: <br /> City: 4)/19#51) Zip: 5c31ig <br /> Home Phone: 7�27'k��/`' y Alternate Phone: <br /> Ccnrtor I €olxllalon::" <br /> Contractor:'`' ' 1( 1 Contact Person: <br /> �` L �, � s g�,r <br /> Address: J6V6� J/ /let State License #: c�a <br /> City: /14 ICIP‘6P0Vi Zipt5V / Expiration Date: Z9y <br /> Phone: 76 Alternate Phone: <br />