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, <br /> 4 <br /> FOR CITY iJSE ONLY <br /> f�Q,y_ City of Orono Date Received: Permit# <br /> J� `�`� P-O.Box 66 <br /> f s�,,;; 2750 Kelley Parkway ❑In-House SAC Determmat�on Form Completed <br /> �a� �� �r';, � Crystal Bay,MN 55323 <br /> '7.��-'�,��, �w��},ui` (952)249-4600 Approved By(If Required): ! <br /> �F�'�o1� `� <br /> CITY OF ORONO— SEWER& WATER/GENERAL PERMIT c <br /> � ,�`,.G�,°`". <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 mHv not be issued when the auplication 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 work must be inspected before it is c re .�all(952)249-4600,24+hour notice required. <br /> > <br /> TYP OF PERN��T <br /> ( eck 1 That A 1 ) <br /> ,� <br /> �Residential(May Require Approval) C �mercial(Approval Required) <br /> _` <br /> . <br /> � New Connection ❑Aaditiona�l`Gonnection �Re-Connection �Repai nect <br /> Job Site/Owner Information: � � <br /> Site Address: � � � _ r � ;�� ��r��._ ��-e�� � a� � ��, S J 3 �� � <br /> Owner: ���'�� 'Cur� � c �u��� �� Mailing Address: ���5«`"�c � <br /> c�ty: I, G �-��- z;p: 5 s 3 `1 I <br /> Home Phone: `� S �`� ��.3 Z Z�� `"� Alternate Phone: �.� I Z. ' `1`1 I - `'1 �3 � J <br /> Contractor Information: <br /> Contractor: Contact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> _ __ .--- �- �k 3� - , l � —1 � :�, ��..:`��� <br /> �r� �--3-_ ��5 1 y� c• �� c k_ f � r � �- <br /> � `�� ��1'�- ��:��'r'1�i— •.- �� �►'��{ f C�c�-�--c�- f�l�.--�.,�L� <br /> Q�`E'�-t�r►'� � , <br /> . . , <br /> �u,_,��ec�� C cmv�-�Cfi�Y� ��►n�� �- . � C -� G�e� <br /> � �,� � �...� ���-� �'�.d � � P I-� —�-�r��-¢�-� <br /> � � <br />