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.. <br /> � ,.— FO CI Y USE ONLY <br /> ��Z��/�l� City of Orono Date Received�G��`('� Permit# � - (�2��� <br /> P.O.E3ox 66 <br /> 2750 Kelley Parkway ❑In-House SAC Determinatio Form Co�qpleted • <br /> �� i � . Crystal Bay,MN 55323 �J�� �7l�L�'�d�j ' � <br /> � -'�'\ _ (952)249-4600/Faac(952)249-4616 Approved By(If I�equired): � <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 aaalication 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 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 Depariment(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 A I ) <br /> �Residential(May Require Approval) ❑Commercial(Approvai Required) <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: �bQ �,�.�,,,a�r�nJ r�p� '�.h <br /> Owner:S,J� `.�,t IQ `��?.�h Mailing Address: �,r�,�, M��;� �,F� S� <br /> city: r���>r���c����"�, zip: �5414 <br /> Home Phone: b\�-�..�`I -yla� Alternate Phone: <br /> Contractor lnformation: <br /> Contractor: C K.,���. �w�t�� ux:le( Contact Person: ����\ �.c��0�.t� <br /> �1 ' <br /> Address: `��,�I Q��.;� �Kw� State License#: sl�o1``•P - M R <br /> City: wv;�e��{X„r� Zip�� Expiration Date: �a-3� - �V <br /> Phone: �\a-'�r�q�� Alternate Phone: <br />