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• <br /> �NL� <br /> ipp_L). <br /> 0 City of Orono nage Rax Pema[ oZ01 7_ <br /> USE <br /> P.O.Box 66 ��'/ 7 <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> �kEs H o4 (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 PERMITS- May be subiect to(nether review and may motile issued wles ffie anoiiratlon 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+honr notice required. <br /> TYPE OF PERMIT . <br /> (Check MI That Apply) . <br /> (Residential(May Require Approval) ❑Commercial(Approval Required) <br /> NEINew Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> 0 Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: k g 3 C 1,✓p A/,/ <br /> Owner: /0%in j Add 17 e S Mailing Address: a a a 0 o La 01 1/vol <br /> A //� rlZip: L <br /> f�-e v� <br /> zggiv <br /> City: � 5-5-0 s—i <br /> Home Phone: 75 a - y l"9 o le/O Alternate Phone: <br /> Contractor Information: <br /> • <br /> Contractor: G1 i-Ds ra cherS 4>ce . Contact Person: ,fh v`v r, . <br /> Address: J 1/y 7v' -, el" State License#: ?8. l)y53 S 7 <br /> City: A/P`'�ma�'�� Zip: �3� Expiration Date: / 7.d //j 7 <br /> Phone: 6 is -?l,l0 -4/995 Alternate Phone: <br />