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• <br /> ' Pon CITY USE ONLY <br /> 1-81-04t-'8\ City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> i 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> s E% Crystal Bay,MN 55323 <br /> \e�1 ¢��� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> kLSH V <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 further review and may not be issued when the aoolication 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 /> ❑Residential(May Require Approval) ❑C s i n ercial(Approval Required) <br /> ❑New Connection ❑Additional Connection I i Re-Connection ❑Repairs J ,Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 19 5VO C't(j0kRNA <br /> Owner: - RtW1gt-Z-0 Z— Mailing Address: I£o gO 4o <br /> City: (5v6 Zip: ES3fl <br /> Home Phone: 11,0 65.b' —`d 6° Alternate Phone: (� -Da/ 'Wes a <br /> Contractor Information: <br /> Contractor: Vo &L £ C((I4iI Contact Person: 7*, VOCILL <br /> Address: Y ' O - Poi 92 s State License#: <br /> s3 7aE <br /> City: ?C('Ixt �- Zip:� xpiration Date: ,/Voile //9/-V/S- <br /> Phone: lila -?,(' - 8 `? Alternate Phone: <br /> C- - 'ire-Ia<fcv O77Zei3- RP <br /> (Fa 6 -p- p ti`0 Arc fl u`i d's bowl Pis (.4/4/6 :?3 <br />