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FOR CITY USE ONLY �� <br /> � City of Orono Date Received: Permit# " �� <br /> ,,,, O� '�O P.O.Box 66 2� 1 <br /> xj;.�N, 2750 Kelley Parkway ❑ In-House SAC Determination Form Completed ��t I �� <br /> � a p��.'7�r;' � Crystal Bay,MN 55323 <br /> ��^���4�i;io$a (952)249-4600 Approved By(If Required)t ��� <br /> '�ssxo$ � � <br /> CITY OF ORONO-SEWER& WATER/ GENERAL PERMIT � <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the ann��cation is received) <br /> GENERAL 1NFORMATION <br /> 1. 1'ou may apply for utility peimits 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. Wark must not begin unless the permit card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed conhactors 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 pernut 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(Approvai Required) <br /> �New Connection ❑ Additional Connection ❑ Re-Connection ❑Repairs ❑ Disconnect <br /> Job Site/ Owner Information: <br /> � � � ��, <br /> Site Address: � � ���� ,� �� S'� ��� <br /> Owner: z`� �-�j Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> �� �� ��� � . <br /> Contractor: � '�� r S Contact Person: �/' �� �Z������� <br /> Address:� �S �C�J���n�/r� State License #: �l �- 1 <br /> . � <br /> City: /`"���'������-� Zip?S?�LExpiration Date: I � � � � �� C.� <br /> Phone: �,�-� ;� ��� �' ���.� Alternate Phone: �y /� `� /� C'.� y/`� <br />