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, ,��1 <br /> ����b17-��Z��! <br /> �M <br /> � ��N�� City of Orono Date Received O� C����rt#Y�_'� �to'��� <br /> , P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> s ,� � Crystal Bay,MN 55323 <br /> '"�,�k����0.E� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (* Vote:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and ma�°not be issued when the apolication 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 wark 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 [b�.Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: l �S� S FPV���,,��� �,p . D�-d"�UO� ��J <br /> Owner: G/�Tc.�E�1 �- V�L� ��}-c.vMailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ����/��^-��n LL C Contact Person: T�''1"� ��s� <br /> , <br /> Address: I�3 �� �-�'�S� State License #: <br /> City: w►�YL�;-r-�-- Zip: �N Expiration Date: <br /> Phone: G,12 �G�- �c=nD Alternate Phone: �o I Z 7`7D ��-3� <br />