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�►+ <br /> ' EOR CITY USE ONLY <br /> ��� City of Orono DateReceived: Yermit# <br /> P.O.Box 66 <br /> ��t,, � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> '�j����2 � Crystal I3ay,MN 55323 <br /> s� y..�'��..o` (952)2�9-4G00 Approved By(If Required): <br /> ���''$$ <br /> a�sx� <br /> CITY OF ORONO— SEWER& WATER/ GENERAL PEI2MIT <br /> (*Note Some permits may require approval by the Building Oflicial and/or Public Works Department*) <br /> (Af L PFRMITS- Nlav be subiect to further revierv and mav not be issued when the apn��cation is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pennits by mail or in person at the City offices. <br /> 2. Mailed in applicarions are subject to the postage and handling fee shown below. Permit cards will <br /> be sent by rehirn mail within 2 business days. <br /> 3. Permits are not valid until you recei��e a permit card. <br /> 4. Work must not begin unless the pennit card is available on the job site. <br /> 5. Utility co�mection permits may be issued to licensed conh•actors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility shib as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET ANll 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 OF PERMIT <br /> (Check All That Apply) <br /> ❑ Residential(May Require Approval) ❑Commercial(Approval Required) <br /> �New Connection ❑Additional Comiection ❑ Re-Connection ❑ Repairs ❑Disconnect <br /> Job Site/ Owner Information: <br /> �/ �` <br /> Site Address: �� � � `��'l� U l ' ''I �� <br /> /� Gt-e�e/� <br /> Owner:yfl- �' i � ? Mailing Address: ���'J ��'�' <br /> � <br /> City: � o �q�. Zip: <br /> Home Phone: ��� ���L' �� �3 7 Alternate Phone: <br /> Contractor Information: <br /> Contractor: v(b't'� .�.e.�:,�ra l.l)�e V Contact Person: Y f <br /> Address: �7�������` � � State License #: �I Z2 <br /> City: .� �— Zip:S�J Expiration Date: ' L �� � � <br /> ,� �� Z ._ b 3SS' <br /> Phone: 7�, � `�7� � 7/ 2_. Alternat� Phone: L 5° <br />