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r / POR CrrV USE ONLY <br /> / OO\ <br /> City of Orono DateReceived: Permit ti 2Cl � <br /> 1 P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 ? cX/9 <br /> CITY(952)249-4600/Fax(952)249-4616 Approved By(If Req <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 PERMM- May be subiect to furtber review and may not be issued when the application 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 /> Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection [a Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Joh Site/Owner Information: <br /> Site Address: 0")L<q Ave <br /> Owner: G_JRAC,S+ Er nSeS Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: 61rofk S c w e 4-1-c-�� Contact Person: —0,,k Al it(ku <br /> Address: T� r l�� State License#: <br /> City: r 1�'""e Zip:55s'40 Expiration Date: <br /> Phone: dl 5 - 6 3 y Alternate Phone: <br />