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f---:-�_ FOR�CiTY USE OPiLY <br /> ��� �r��,` City of Orono Date Received: �fZ/�P�rmit# �_�_�_�j� pJ1 <br /> P.O.Box 66 7—r J V <br /> 1 � } 2750 Keiley Parkway ❑In-liouse SAC Determination Form Completed <br /> �, 1 Crystal F3ay.MN 55323 ="yt�C� l�d Z�I� ._C�l��C� � <br /> ��'�•_."rq��� � (952)244-�600/Fax(952)249-4616 Approved By(lf Required): ����� <br /> . r,,,w��r r Y� <br /> C1TY OF ORONO—SEWER & WATER/GENERAL PERMiT <br /> (*Note:Some pernii[s may reyuire approval by the Building Officiai andinr Puhfic W'orks Depailment*j <br /> IAL.L PFRMiTS- Ma�be sub,ject fo 1'urther review and mav not be issued when the anplication is received} <br /> � GENERAL INFORMAT[ON <br /> i. 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 reiurn maii within 2 business days, <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the perinit card is availabie on the job site. <br /> 5. Utility connection�ernaits rnay be issued to licensed contractor�on1y. <br /> 6. Contact the Public Works llepar�ment(952-249-4600}for utility stub as-buift Ioeations. <br /> DO NOT EXCAVATE IN ANY STREET'AND DO:yOT TAP ANY MAIN without express <br /> approval of the Public Works Department. Issuance of a permit does not grant this approval. <br /> 7. All wurk must be dane in accordance with State Code requirements. <br /> 8. All work must be inspected before i#is covered. Calt(952)249-4600,24+hour notice required. <br /> -- - -- ----- TYPE OF PERMIT - - ------� <br /> (Check All That Apply) <br /> �Residential(May Require Approval) ❑Commercial (Appruval Required) <br /> � <br /> � New Connection ❑Additional Connectian [Y] Re-Connection [,_] Repairs [Y] DisconnecY <br /> ❑ Water Availability C:'onnectian For Future Hook-Up to Water <br /> � Job Site;Owner Information: � <br /> Site Address: � � �� ��-�S�-L��Z ��v ��� <br /> Owner: ��I;�t�.S�-�`�C:�.c� (�--� Mailing Address: I �(� ?C ������L�C-��v��0.•��- <br /> City: �L�I 1�Y� Lip: S.`� ��� 1 <br /> Home Phone: 7 4� � `� 7 `1 - �'`f z�= Alternate Phone: <br /> Contractor Intorrnation: �� <br /> Contractor: �)`,-��L��'�-� �' l�C. Contact. Person: ��a-�� <br /> .r <br /> Address: l �L� C: 1-tX.VY�..�Y�,� �Y(�.,E State License#: <br /> City: �ld,�Y�+l Zip:`���(I Expiration Date: <br /> Phone: 7 l� � �Z� (� �'� � Alternate Phone: �� Z ����s' (v C'�`%1 <br />