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� � . <br /> . ' FOR CiTY US�Q1�tI,lC <br /> O,¢0,�`O City of Orono I)aate Received; Permit# <br /> `r P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC Detemm�ation Form Corn�leted ; <br /> � , ; ..:.� Crystal Bay,MN 55323 <br /> ��op� <br /> (952)249-4600 Approved By(If Required}: <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 aualication is receivedl <br /> GE�ER�L INFC1i�MATTt�i�T : <br /> 1. You may apply for urility 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 retiun 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. Urility connection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Deparhnent(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 QF PERMTT ' <br /> (Check All'�'hat A 1 ) <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> �ew Connection ❑Addirional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> Job Site I C)vvner Infc�rmation: <br /> � � N9d 1 �A�� <br /> Site Address: � , <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Cont�actor Informatian: ' <br /> , l i !� <br /> Contractor: S U��� � w Contact Person: i���✓� ��c�'' ( <br /> � e <br /> Address: �� • !-S State License#: ;���0�? �D Of�jn�'! <br /> City: ��� Zip 5��� Expiration Date: `2'3�� � � <br /> Phone: � ��o�`y�I S Alternate Phon�6 la ���' S�� S <br />