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FOR CIT'Y USE ONLY <br /> 'O¢p�O City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC Detennination Form Completed <br /> '� r+'�• ; Crystal Bay,MN 55323 <br /> ��,, `o (952)249-4600 Approved By Qf Required j: <br /> s�xo8 <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (•Note:Some permits may require approval by the Building OfYicial and/or Public Works Departrnent') <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoplication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utiliry 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 wili <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 A 1 <br /> 0■ 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 Information: <br /> s�te aaa�ess: 925 Partenwood Rd <br /> Owner: Mailing Address: <br /> Orono <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Olson Construction Ronald Olson <br /> Contractor: Contact Person: <br /> 6970 Inwood Rd 075033-RP <br /> Address: State License#: <br /> Cologne 55322 <br /> City: Zip: Expiration Date: <br /> 952-448-6674 612-369-4240 <br /> Phone: Alternate Phone: <br />