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.� t <br /> R(� �C[�'�i S��IY�Y �; <br /> �,�p�� City of Orono �at��3teee�v�d� ���'�Perr�t�t �"'"` <br /> P.O.Box 66 : ` .� ��� <br /> 2750 Kelley Parkway []In;=,Fiause�SAC Determmadon°Form�mpleted : <br /> a,,, ,� � Crystal Bay,MN 55323 ' �! � ,: - <br /> �� (952)249-4600 Appr�ed By��3t'12egi�fred) <br /> CITY OF ORONO-SEWER&WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approva]by the Building Official and/or Public Works Deparhnent*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoolication is received) <br /> C�E�TER�4L zIlV���TT�'� '. <br /> 1. You may apply for urility pernuts 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 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 /> � * � �`�������� �' ` <br /> ;� _� � ��: �hec"����'�'�a� � j � <br /> � <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> �New Connecfion ❑Additional Connection ❑Re-Connecrion ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connecrion For Future Hook-Up to Water <br /> Jm���fe✓(�wrie�'I�pr��i�ri ���' � <br /> Site Address: _1 �d,5 ��� G2 �,�z.�— <br /> Owner:��v��� ��,�,ti ,f�c�� Mailing Address: l ������ <br /> , �_ <br /> City: /�i�✓t,�— Zip: <br /> W <br /> Home Phone: Alternate Phone: <br /> �ontrac�����ri�aat�on� _: . <br /> � , 4 <br /> Contractor:�--��i�u- �%� ,��ontact Person: <br /> d �r 1�.� ��/, a�-y,. <br /> Address: 7��� U �%eyrv-� �r- State License#: �j� � ' 7 �f� <br /> City: Zip: Expiration Date: � ��� / ^ �O <br /> Phone: 7���� ��-�%C,c �' Alternate Phone: � f 2 �9� '�l- `� � J <br />