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EQR CTTY USE ONLY <br /> � City of Orono Data Received; Permit# <br /> O� '�O P.O.Box 66 <br /> ��„rry 2750 Kelley Parkway ❑In-Hocue SAC Determination Form Completed <br /> +� s. ,,. Crystal Bay,MN 55323 <br /> ?����� (952)249-4600 �PPxov�d F�y(If 12equired): <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- Mav be subiect to further review and mav not be issued when the aoolication is received) <br /> NERAL �NFC)�MATI�N ' ':, <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications aze subject to the postage and handling fee shown below. Permit cards will <br /> be sent by return maii 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 /> ` ' TXPE�F PER.IUIIT' <br /> �'� Glieek Al��'hat A �� 1 � <br /> ��Residential(May Require Approval) ❑Commercial(Approval Required) <br /> �New Connection ❑Additional Connection a Re-Connection �Repairs ❑Disconnect <br /> b Site!Ovune�r I�c�rtnatic�n: '' <br /> Site Address: j�� K�SST �D/ti.11� Ii2GLL1 <br /> �n' L�W JV t. lVlG�.'L" _I <br /> Owner:(.���IvI SITLLCG1ZClZ.�:,� MailingAddress: /��/ /Z �lLS b�/ULJ� ��d`3o�' <br /> Ciry: �IZGI�U zip: (�,�i�Z4rZa-,�, M{'L� 5�.��'// <br /> Home Phone: �GISz� �/�.� "90L/v Alternate Phone: �lD/Z ) ��''J(o � ��1�� <br /> antracto��nfcirmatiari: ' { <br /> Contractor: bLe,2/lJS �XC/4VG�YTIKl� Contact Person: ��%1/L /211.'S <br /> Address: ��17D �d• /ZGl• Z� State License#: ��S�Sg � <br /> City: 2ip:� Expiration Date: .3 l Z��1�� <br /> Phone: ��S Z� 9SS ��//Z Alternate Phone: � IZ� �05 -L�.36-� <br />