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.' , a� <br /> �----.. �j� '/ <br /> ������� City of Orono ����Y <br /> Date Recei�ed���!����p�{# o2D��� ��Y'� <br /> �` � P.O.Box 66 <br /> � ; 2750 Kelley Parkway ❑In-Honse SAC Detem�inarion Form Completed <br /> '�y �-�' Crystal Bay,MN 55323 <br /> �\�At,�� (952)249-4600/Fax(952)249-4616 Appmved By(IiRequired): <br /> CITY OF ORONO–SEWER& WATER/GENERAL PERNIIT /D/• �� <br /> (*Note:Some pemiiis may require approval by the Building Official and/or Public Works Department') <br /> (ALL PERMITS- Mav be subicct to furt6er revfew and mav not be ic ued wheo the an�licadon is received) <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 aze subject to the postage and handling fee shown below. Permit cards will <br /> be sent by retum 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 ezpress <br /> approval of the Public Works Department. Issuance of a permit does not grant this approval. <br /> 7. All wark 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 A 1 <br /> ❑Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> �New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner In#'ormation: <br /> Site Address: �z� ��� �i�-J G{/G�'��'/�- <br /> —� <br /> Owner:� �kQ lr S G Uc�i� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractar Information: <br /> .� � / <br /> Contractor: �j�l�7���/C.f Contact Person: '/�`` � l'`� �j� <br /> Address: �i�/�U���i�G�/r/L��v�� State License#: <br /> City: �j�G�`�9�r Zip:���z Expiration Date: <br /> Phone: �/Z�y�y���d Alternate Phone: <br />