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� , <br /> RE��IVED F CITY USE ONLY�^ <br /> ��nlO City Of Orono y�„ +� q Date Received i Permit# �T/l�—� �� <br /> P.O.Box 66 I 1�1� .6 ,� LQ 17 <br /> 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> ��,�K���� ���� (952)249-4G00/F�����,�N� Approved By(IfRequired): <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 PERMfI'S- Mav be subiect to further review and mav not be issued when the aoolication 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 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 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 /> ❑ 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: I?�o S P��p Y��.vo0 ,�1� , ,20�� rti Il� 5�3 (o�}- <br /> Owner: G'2►:TC.H1�+� f1-tJjp �� Mailing Address: 7vp r �A�GST�v pe <br /> S��� <br /> City: �D�� 1�6��-s-�.T}�' Zip: S�3 ��_ <br /> Home Phone: �v ��- -3���7� A Iternate Phone: <br /> Contractor Information: <br /> Contractor: � I S3 � �-�K-� SI Contact Person: I�y`-�-t�►�- �or.�5 <br /> � <br /> Address: y S�������� .� State License #: bL sy � '�1 S <br /> City: f� Z� Zip:_�11 Expiration Date: <br /> Phone: �� ��-� 77a'�a-3) Alternate Phone: ���- �-{�(,� �U� <br />