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. � ; <br /> FOR C( Y C�SE ONLY <br /> (� City of Orono Date Received:�� Permit# �/�—'Q���� <br /> � �`� P.O.[3ox 66 <br /> � ����' 2750 Kellc Parkwa <br /> � y y ❑�n-House SAC Determina[ion Form Completed <br /> � �f�� ��' Crystal f3ay.MN 55323 � � <br /> o`, (952)249-4600 Approved By(If Required) <br /> ��?Gr��oe�o' - <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 aonlication is received) <br /> GENERAL INFORMATION � <br /> l. 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. Pennit 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 I }; <br /> � Residential(May Require Approval) � Commercia) (Approval Required) <br /> ❑ New Connection ❑Additional Connection ❑ Re-Connection ❑ Repairs ❑ Uisconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: ���� CG� l ��� � <br /> �-` C'� <br /> Owner: �1��� � �� � Mailing Address: _ <br /> City: �(�1� U Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor lnformation: <br /> I o��.rc�� S���-i-�� a,�,.l���� <br /> Contractor: Contact Person: <br /> f ' I � , ' n p <br /> Address: (o��� W�� �`' State License #: 1� ► �� � � � l� <br /> � �-aa �r <br /> City: ����� Zip:�3 Expiration Date: <br /> Phone: ��0 3` ������ Alternate Phone: ��������� <br />