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, RECEIVED /L�/. �-�` <br /> • ��� � � �Q FO CITY SE ONLY C� <br /> ����`�� City of Orono Date Receive �t ermit# ����— �P� / <br /> � �` P.O.Box 66 <br /> r� . i <br /> I ` � � 2�50 Kelley Parkway (r��OF OR �-House SAC Determination Form Completed <br /> �� Crystal Bay,MN 55323 <br /> �'��``� .� '1' (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> '�'��tcsiio�-F�% <br /> CITY OF ORONO—SEWER & WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Depardnent*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoolication is receivedl <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 receiv�e 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 gant 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) ❑ 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 /> Site Address: f�SY 59N�J�N� ������ <br /> Owner: ��Q�y �'C0�• Mailing Address: <br /> City: d��� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ,���,/�l. ��At��fNL �NG. Contact Person: /�i�� Got%��,.v� <br /> Address: 29/� �iv'/�t,A¢is� �• State License#: <br /> City: Hi9J��✓G,S Zip:�33 Expiration Date: <br /> Phone: G �' y��'���� Alternate Phone: �/�"�9l 9'y3�� <br />