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SE ONLY <br /> .8.O4/ \ City of Orono Date Received (/_ 0 <br /> Penait# `6- jc3b <br /> P.O.Box 66 1PPP���� <br /> ` 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> j � tJ Crystal Bay,MN 55323 <br /> \\4 ,C (952)249-4600/Fax(952)249-4616 Approved By(If Required): (;) 00 <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 /> 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 /> ba Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection 0 Additional Connection 0 Re-Connection 0 Repairs J Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 1330 OCON0 L <br /> Owner: L.0 Ko Q.,\ t\;L V Mailing Address: 36\i AuQ,S <br /> City: M:mno.c.,�c�\= s Zip: _SSO9 <br /> Home Phone: WI 3 L\-1 3i b Alternate Phone: <br /> Contractor Information: <br /> Contractor: Cc C^�tyL�pu r h ItS Contact Person: (21:\ Qp ft n <br /> Address: �� �Uc> \ nr< �I State License#: .5134.4A - /A <br /> City: vacx 2(\4niN Zip Expiration Date: \ <br /> Phone: Ra-Sc -eIeCiLk Alternate Phone: <br />