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FO I ONLY <. <br /> �,�0�� City of Orono Dat Recei �ertriit# t 7 <br /> P.O.Box 66 <br /> Boto <br /> 2750 Kelley Parkwayil <br /> Din ousel Determination FormCompleted <br /> :?� Crystal Bay,MN 55323 <br /> :,i (952)249-4600Appfoved By(If Required) <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERMIT <br /> (A 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 /> GE ERA R A`1ON <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 maybe 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 /> x ,T1'PEp{.�PE RT <br /> 4�(+ %k�E l "4:1,---4,-,:- <br /> ly .` - I. <br /> ❑Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ®New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site;/Owner worm n. <br /> Site Address: ) 0 Q ,-o v\ o O r a A <br /> �i-vi\p � it-Ac cot 4 S �` <br /> Owner. 1" ' .1 '� L Mailing Address: S A v,‘-e <br /> City: 6i Atl 2 4'\---A Zip: SS 3 5 ) <br /> Home Phone: 76 3 (..--i 7 g- Alternate Phone: f 2 2_7 o cj L 3 k <br /> Contractor'Information <br /> Contractor: G se.,...0---) Contact Person: (9‘) ) <br /> Address: -2 ? C '(D.-.--,--1 O- State License#: S 6 b ( P A\ <br /> City: Zip: Expiration Date: 1243) ) /J <br /> Phone: 3 y-7 - (0 1 11-- Alternate Phone: G 1 �- - 2 S 0 _L35 s- <br />