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� � ���c I�d �!3 rs`. <br /> ��,��j,�,p��� � I <br /> — FO�USE ONLY ,7 r /_�'Z <br /> y�-��/� City of Orono Date Received: Permit# G��J—�/ l(J <br /> �1 P.O.Box 66 <br /> �� �. 2750 Kelley Parkway ❑in-House SAC Determination Fortn Completed <br /> Crystal Bay,MN 55323 <br /> ��`�"` (952)249-4600/Fax(952)249-4616 Approved By(lf Required): <br /> i �� <br /> ` 'ar�:;�. <br /> C1TY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Officiai and/or Pubtic Works Depanment') <br /> {ALL PERMITS- M�v be subiect to further review and mav not be issued when the a�olication is received) <br /> GENERAL iNFORMATION <br /> 1. You may apply far 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 oot valid until you receive a permit card. <br /> 4. Work must not begin unless the pernut card is availabte on the job site. <br /> 5. Utility connection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)far utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY iNAIN 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. Cail(952}249-4600,24+hour notice required. <br /> TYPE OF PERMIT <br /> Check All That A 1 <br /> �Residential(May Require Approval) ❑Commercia!(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 Information: <br /> Site Address: 4��3 �C�.��s�y�� (�2�� ,C _ <br /> Owner:� �� � � j (, B��'"� Mailing Address: � � �� 7 C? �, V�iL�C,1DY[ f Gt,K� <br /> c�ty: i�i� z�p: S S 3z � <br /> Home Phone: Alternate Phone: -7�� ' �7� - G:����(�.� <br /> Contractor Information: <br /> Contractor: ����J`��-✓�l.� ��� Contact Person: �a�S ��'F�wu,V+— <br /> Address: ����� ��1�1�n�'I��./1/� State License#: <br /> City: ;�t,'vl,�l'�.,�� Zip��l Expiration Date: <br /> Phone: ?� '� `f�`E-���d Alternate Phone: (v I Z ?�;�� (;��,���j f <br />