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4 , <br /> r.,..„..„ ]RO C ilSPs ONi,i' qry p„ City of Orono nate Received psit q p7l'-(�D7; P.O.Box 66 // / <br /> tii 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> \r�esHo�,G` (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> CITY OF ORONO-SEWER&WATER/GENERAL PERMIT 00 <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- May be subiect to further review and may nettle issued when the annlieation is received) <br /> GENERAL INFORMATIOl <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) 0 Commercial(Approval Required) <br /> CRINew Connection ❑Additional Connection 0 Re-Connection ❑Repairs ❑Disconnect <br /> 0 Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 02 5'75- O/vvr -,,- /// <br /> Owner:(-pc”'4'7 1-; -e Mailing Address: a a a to O h so)d L/vo" <br /> City: L,r VPvt 1/ Zip: s�° <br /> Home Phone: S)-- '`ie - '710(e G Alternate Phone: <br /> Contractor Information: <br /> Contractor: Contact Person: jcz, r r/ n Z'i, /.e1 <br /> Address: y1/2/ �V`�1 `� State License#: /1/ 9 <br /> ssosy <br /> City: A/�'`'`J � K Zip: Expiration Date: /a - (7 <br /> Phone: ie is ^7h6 - `7/775- Alternate Phone: <br />