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r <br /> y FOR CITY USE ONLY <br /> ,�0� City of Orono Date Received: Permit# <br /> O y O P.O.Box 66 <br /> �;i,,,,� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> a� �j�'?�;�'. Crystal Bay,MN 55323 <br /> t� "t�:�" o� 952 249-4600 A roved B If Re uired : <br /> �fqh�y ( ) PP Y( 9 ) <br /> �aoe <br /> CITY OF ORONO- SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Ofticial and/or Public Warks Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoplication 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 pernut 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 /> ❑ Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection �Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> Job Site/Owner Information: <br /> Site Address: �� ��� �F -��i,� a�� L�c�c.� � � �-�`����� � <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractar: ��, �C�� ��u�k�" � ��c�,.r.,_ Contact Person: ���� <br /> Address: 7��'�� ��^�jcrl-��� �`��'c/� State License #: ����� � <br /> City: l�rue��,t, Pr✓� Zip:�s��/z,� Expiration Date: �Ci G <br /> —� <br /> Phone: -7(��-S�7-�f'G s�O Alternate Phone: �/..Z-C���/ _ c�,(�� C'P l/ <br />