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. <br /> . <br /> � <br /> - ' -� FOIj,CI'J',Y jJSE ONLY <br /> �' c��/�/� City of Orono Date Received: Q�I���XI1:S permit# <br /> � ', P.O. Box 66 ��— <br /> ` � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �, i - Crystal Bay,MN 55323 <br /> `.`.` ��-`�' (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> ``�n'rs��,,� , <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building O�cial and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the analication 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 covered. Call(952)249-4600,24+hour notice required. <br /> TYPE OF PERMIT <br /> (Check All That Apply) <br /> sidential(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 /> Site Address: � �.� U _) �,Zi�,�12 /y!���?� <br /> Owner: Mailing Address: <br /> City: �,��r� Zip: <br /> � <br /> Home Phone: G�� -�G8'�?�� Alternate Phone: <br /> Contractor Information: <br /> �Contractor: � ,��� Contact Person: �? <br /> Address: State License #: ��� � � <br /> ltil �S��� ' ) <br /> City: D' Zip:� Expiration Date: � "' � Y <br /> Phone: ���-�7����Z . Alternate Phone: <br />