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4 . - <br /> Polt CtrY VsE ONLY <br /> ("4.145A-si,\ City of Orono Date Received: Permit S <br /> P.O.Box 66 <br /> 2750 Kelley Parkway 0 hi-Hoare SAC Determination Form Completed <br /> y� ,Z Crystal ay,MN Sax 3 <br /> (9 <br /> . Hoge (952)249-4600/Fax(952)249-4616 Approved By(ff 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 /> 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 0 Repairs ❑Disconnect <br /> 0 Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: d3 5 0 O/1 vac f// 7/ <br /> Owner: 1/0 t),51)41 S Mailing Address: a a a 6 ®dol. R I v I <br /> City: La K- vtJ1P Zip: 1;S-I1f9. <br /> Home Phone: c75-a -1/6 7" `i°to(P Alternate Phone: <br /> Contractor Information: <br /> G - <br /> Contractor: (; do.s /�11)5-• \C* P Contact Person: <br /> Address: `/// / T� of State License#: 1=. (' 2-1 S 57 <br /> City: la �°°/l Zip: .5-,/ <br /> xpiration Date: )a // // <br /> Phone: &/d.16 io -VIC Alternate Phone: 1, /o� "f t -`0'73- <br />