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FOR CITY USE ONLY <br /> 74:41- <br /> g'1 City of Orono Date Received: Permit# <br /> 74:) P.O.Box 66 <br /> �‘k'''''' <br /> , ti 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> \ ��' ,:'. t Crystal Bay,MN 55323 <br /> ....e (952)249-4600 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 subject to further review and may not be issued when the application is received) <br /> GENERAL INFORMATION <br /> I. 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 /> , New Connection ® Additional Connection M Re-Connection 0 Repairs 0 Disconnect <br /> Job Site/Owner Information: <br /> Site Address: /-C--- C (2/- -e---h a /- tg • a el /,4,c <br /> Owner:/ i h . 1 Cu S'7 et 0-7 //drmiz,piling Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ..f,n o 2/ e Y £'c S.,'vr c,ogontact Person: deiit -'(mr 69-77.e S <br /> Address: S 2c) 6/4or,4 -P State License #: d 7'rq <br /> City: /---dehSieti P,g, Zip.63"1/4/61Expiration Date: <br /> Phone: -e ��yr 26 Alternate Phone: 6 l,;-7�/—ef:1"- 9'_ <br />