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� <br /> � z <br /> �OR CTCY ll�i's OI�fiI,Y r5 <br /> �'���0� City of Orono Date Recei�ed: P�ii# �D I7—v SI,j <br /> ; P.O.Box 66 <br /> ; 2750 Kelley Parkway �In-I�onse SAC Determination Form Completed <br /> s ,�-f Crystal Bay,MN 55323 <br /> ``�,� • ¢�,�� (952)249-4600/Fax(952)249-4616 Apploved B (I1' <br /> acsHo Y �9uired): <br /> D/ Dfl <br /> CITY OF ORONO—SEWER&WATER/GENERAL pERMIT <br /> (*Note:Somc peamits may require approval by the Building Offieial and/or Public Works Departmq�t') <br /> (ALL PERMITS- MiV I)t���hinwf�n f��rfh*�rrvSrw,nd mev nnf�+M��a_,�._-.+.��__.�_-oon is r V 1 <br /> GEI�ERAi,INFORMATIOI� <br /> 1. You may apply for urility permits by maii or in person at the City offices. <br /> 2. Mailed in applications are subje�t to the postage and handling fee shown below. Permit cards will <br /> be sent by return mail within 2 business d.ays. <br /> 3. Permits are not valid until yon receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> S. Utility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600j for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MA.iN without express <br /> approval of the Pubtic 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 /> TY#'E OF PER�T <br /> Check All Th�t A <br /> ❑Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ VJater Availability Connecrion For Future Hook-Up to Water <br /> Jo� Site L Ovvner In#'o�ation: <br /> Site Address: � �°7 5�_,�,�_ �,r � <br /> Owner: Mailing Address: <br /> City: �� c-.�,n.r� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ���`'y�-��50.,,y Contact Person: � ��,i�- <br /> Address: ��`�b, Ca Q.�� 3 State License#: P� � y�iy �3 <br /> City: �-�� Zip:��I�i Expiration Date: )Z � <br /> Phone: �15z Cl j�' `'(/3� Alternate Phone: �I Z y �4 z`c S� <br />