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i � /D/ � <br /> o���.� ����.,Y !/�.� <br /> '�- �O; City of Orono Dace Received:L�'�!i-,l S Pe�mit# D�/.� <br /> 11 P.O.Box 66 <br /> ) 2750 Keiley Parkway ❑In-House SAC Determination Form Comphted <br /> �y �-f Crystal Bay,MN 55323 <br /> \k�SH 04'�L� (952)249-4600/Fax(952)249-4616 A p proved B y(I�R e quired): <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERNIIT <br /> (*Note:Some permits may requin approval by the Building Official and/or Public Worlcs Departrnent') <br /> (ALL PERMTfS- Msv be subiect to further review and mav not be issued whee t6e aonlicatlon Is rrrpivedl <br /> GEI�iERAL INFORMATION _ <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 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 e%press <br /> approval of the Public Works Department. Issuance of a permit dces 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+6our notice required. <br /> TYPE OF PERNIIT <br /> Check All That A i <br /> [�Residential(May Require Approval) ❑Commercial(Approval Required) <br /> �� 0. <br /> �New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connecrion For Future Hook-Up to Water <br /> Jab Site/Owner Infarmation: <br /> Site Address: G�Z s,�,�d��� ���c�� <br /> Owner: ���AY ����, Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: �,/�l, L�44Y��b ��-Conta.ct Person: �fi� C-��a��✓� <br /> Address: Zp�� � , s�/`1�• State License#: <br /> City: �s Zip: �s� Expiration Date: <br /> Phone: �S�f� �g��3�` Alternate Phone: lyl%� G�2 9�9 ��� <br />