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. � . <br /> �/D/. U�? <br /> %."_-` FO�C���USTi.6NLY �� p� <br /> i R�/�!`�� City of Orono Date Received: ��--��1�„ic# D/ a <br /> � �' P.O.Box 66 <br /> I!� 1' 2750 Keiley Parkway ❑In-House SAC Determination Form Completed <br /> � �-;' Crystal Ba MN 55323 <br /> ����`\�1�¢F,j (952)249-4600/Fau(952)249-4616 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 Departrnent') <br /> (ALL PERMITS- Mav be subiect to furt6er 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 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 /> ,/' <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: �oro`/ �fl�✓bS��/� Cx�� <br /> Owner: �7Qn/�'BRy �GD/LS fi�.�'i Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ���aM. ��i4�/y4�'�✓G �N�Contact Person: /I�i� �o��I2„✓� <br /> Address: Zp/� �����s��. State License#: <br /> City: sYN b5 Zip:��3,.3 Expiration Date: <br /> Phone: lv��' yg���3�� Alternate Phone: �12 9�9 y3y� <br />