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� _ . <br /> � . f <br /> �� , � <br /> '—"\ �O/g , ITS�OTTLY <br /> ��N��\ City of Orono Date Recei�ed:��/�Pe�mit# O��S� � <br /> ; P.O.Box 66 <br /> 2�50 Kelley Parkway ❑In-Hoese SAC Determination Form Complaed <br /> _� ,�� Crystal Bay,MN 55323 <br /> \� k�SH�¢�� (952)249-4600/Fax(952)249-4616 Approved By(It'Required): <br /> \ <br /> -.__� <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT �(,�� <br /> (*Nota Some permits may require approval by the Building Official and/or Public Works Departrnent') � <br /> (A�.L PERMITS Mav be subiect to[urthcr review and mav not be issned when e an catlon is ivedl <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 cazds 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 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 /> TYPE OF PERMIT <br /> Check All That A 1 <br /> (�Residential(May Require Approval) ❑Commercial(Approval Required) <br /> i- <br /> (�New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner infarmation: <br /> Site Address: �oLd �ANa���- ����LE <br /> Owner: ���A,y ,Beo�r L,e� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: U.�,/�I. t�cc.Av�rrNL �N�� Contact Person: /7'l/,� ��ee��r�� <br /> Address: 29l� ���� State License#: <br /> City: �-rN65 Zip:�S'�'33 Expiration Date: <br /> . . /�fii�4. <br /> Phone: �i=/-y8�'13vr$ Alternate Phone: �A/2 �/9 �y� <br />