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�r,� � <br /> FOR CITI'USE ONLY <br /> �'��(�p'`�` City of Orono Date Received: Permit# <br /> tlO�' `�`Q�, P.O.Box 66 <br /> �� .� . � 2750 F:elley Parkwa}� ❑In-House SAC Determination Form Completed <br /> ��� �l� �.•:�-- �� Crystal Bay,MN 55323 � <br /> '\�'�;r,r�1���,G`� (952)249-a600 Approved By(If Required): � <br /> � �oa.. <br /> �-:_---=- <br /> CITY OF ORONO—SEWER & WATER/GENERAL PERMIT <br /> (*Note:Some pennits may�require approval by the Building Official and/or Public Works Department*) <br /> (ALI,PERMITS- Mav bc subiect to further review and mav not be issued when the aoplication is receivcd) <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 Department(952-249-4600)for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANS'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 1 ) <br /> � Residential(May Require Approval) � Commercial(Approval Required) <br /> �1ew Connection � Additional Connection � Re-Connection � Repairs ❑ Disconnect <br /> Job Site/Owner Information: <br /> Site Address: a � (� S �.-�t� t-vr�� �c� <br /> Owner:�fe,�,�,��., L--a�,�y,,,,.,�,,,,,,,� Mailing Address: <br /> City: C�,a...-(.,�s �� ;-� Zip: <br /> Home Phone: Alternate Phone: � /o� �U( bSa� <br /> Contractor Information: <br /> Contractor: 5�_(�.�.---(��- Cfl LL C., Contact Person: ��� <br /> Address: /�y( — �,�t I l_� �j�, State License #: � C..,1 ���y <br /> City: �o� �-S Zip:��y Expiration Date: �� � �� <br /> Phone: ��, "?� - ��7— / � 13 Alternate Phone: (�/ol-o��o� - -7 �'o� <br />