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� . / e �� <br /> � <br /> . __... RECEIVED F(� CIT USE ONLY <br /> j���10� City of Orono Date Received;.�y0�;�.*"_.�ermit# � �/C� <br /> �, P.O.Box 66 fyqY z 7 z016 <br /> I 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �: � �; Crystal Bay,MN 55323 <br /> �\��j.�',�'�¢�j (952)249-4600/Fax(952)2�������NO Approved By(If Required): <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 turther 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 of�ices. <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 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 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: ��� S�^'��'✓� �+��L� <br /> Owner: ��8�'y ,dLO�+S, Mailing Address: <br /> City: O�Ar✓� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ���,/�l ���N� !N�- Contact Person: �I�L�' (id�l�-r�✓ro <br /> Address: ��/� ��-lJ�is��L State License#: <br /> City: .fLl;�✓ Zip:���3,3 Expiration Date: <br /> Phone: G ff• ��/��� Alternate Phone: �/Z;�l9��1'3�/� <br />