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��^\ FU I Y ll�i's ONI,Y ,C�� <br /> ����� City of Orono Date Received:� I'er�it N �I�� (/v � � <br /> '•, P.O.Box 66 � <br /> ` 2750 Kelley Parkway ❑In-Hoase SAC ination Form Com ed <br /> i s� ,Z-� Crystal Bay,MN 55323 � <br /> \\�is�io�-�'�` �952)249-4600/Fax(952)249-4616 Approved By(Ifittquired); <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERNIIT <br /> (*Note:Some pe�mits may require approval by the Building Official and/or Public Worlcs Departroont•) <br /> (AI.L PERMi7�_ ]y�v be subiect to fi�+h�*�p�•�w and mav not be issaed when We aooli aK i� ;�-a� <br /> GEr�E��IIVFORIv4AT'IOI� <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 cazds will <br /> be sent by retum mail within 2 business days. <br /> 3. Permits are not valid until yoa receive a permit card <br /> 4. Work must not begin unless the permit cazd 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(952-249-4600j for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without ezpress <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 /> TYf'E dF PER�T <br /> Check All That A � <br /> (�f Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> (� New Connecrion ❑Additional Connection ❑ Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connecrion For Future Hook-Up to Water <br /> Jo� Si#e/Ov�er In#'o�ation: <br /> Site Address: �30 5<IN1�N�u. G�-. <br /> Owner: ���� hV�[�.y �/�s, Mailing Address: <br /> City: Qi�4N6 Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ���,,/�I, �1',Ahr9`e���Gli►�C.. Contact Person: �i,�� �aL�/�„�i,� <br /> Address: / �� � State License#: <br /> City: .NL Zip: ��� Expiration Date: <br /> Phone: �is/, y8'D./3� Alternate Phone: �a/2� 9�9y�y� <br />