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FOR CIT USE ONLY <br /> O¢�A�O City of Orono Date Received� Q Pemiit# ��Q� �Q 7� <br /> �r P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC Detenninalion Form Completed <br /> � l '• � Crystal Bay,MN 55323 <br /> o` (952)249-4600 Apprwed By(If Requued): <br /> �R�o�� <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERMIT <br /> (•Note:Some pecmits may require approval by the Building Official and/or Public Works Depattment*) <br /> (ALL PERMITS- Mav be subiect to f�rther review and mav 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 retum 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 EXCAVA'I'E 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+bour notice required. <br /> TYPE OF PERNIIT <br /> (Check All That A 1 ) <br /> Q Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑New Connection ❑Additional Connection �Re-Connection ❑Repaus Q Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> � �Site Address: �' 6 �S � � ��- � f� <br /> Owner: ��Gt�c��-�ij-+ Mailing Address: /1�w�s- <br /> City: �/�o� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: �� Contact Person: �i"�"' � <br /> Address: z z 7�3 W-�.•.c�l�ce..�c�7�� State License#: <br /> City: Zip:s5�3�o Expiration Date: <br /> Phone: 7G 3 �9 8 8'3/9 Alternate Phone: 6�Z g6 g 8'°72 �Cv.Q�I <br /> / <br />