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� . � <br /> FOR�15E ONLY <br /> „,¢0 A�\ City of Orono Date Received: D Permit# �DID— ya� <br /> `�` P.O.I3ox 66 <br /> � Q��' 2750 kelley Parkway ❑ln-House SAC Determination Form Completed <br /> � r�*ye �-;'� Crystal Bay,MN 55323 <br /> ;� ;�c,`, (952)249-4600 Apptoved By(lf Require�d): <br /> �.��xaa, - <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 Turther review and mav not be issued when the aoplication is received) <br /> CENERAL INF'ORMATION � � � � � <br /> I. You may apply for utility permits by mai)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 eapress <br /> approval of the Public Works Department. [ssuance 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 /> � <br /> Site Address: �/ �`� —� � / I "e � <br /> ln 1 <br /> Owner: � �C !G,{�I, I� n- �> Address: <br /> � <br /> c��,: b�� f2� z�p: _ <br /> Home Phone: Alternate Phone: <br /> Contractor Information: � <br /> ' C <br /> Contractor: � � �Q-�� ���)�Contact Person: ���Q-�� <br /> Address: l��� l �"`StateLicense #: ✓��C� ���� <br /> City: �Cl/1'l �V� Zip��I Expiration Date: ( � �'b� ' <br /> Phone: � � � ` � / d '��U� Alternate Phone: �(�3• o'" � � � /� <br />