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1011912017 10:54 FinalGrade iFAlg952 492 5101 P.0041006 <br /> c <br /> FOR CITY USE ONLY <br /> 110/�I City of Orono Date Reoeived: Permit# <br /> P.O.sox 66 <br /> 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> rysial Day,MN 55323 <br /> 9C 5 9.4600/Fax(952)2494616 Approved By(If Required): <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERART <br /> ("Note:Some permits may require approval by the Building Official and/or Public Worke Pcpwtment") <br /> (ALL P&RMETS- Mav be subtect to further review sad may not be issued when the aooHcatioo is secabmil <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)2494600,24+hour notice required. <br /> TYPE OF PERMIT <br /> Check All That Ap2W <br /> AResidential(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: 1� , <br /> Site Address: �[D� <br /> weer: Mailing Address: <br /> City: r/ n Zip.- <br /> Home <br /> ip:Nome Phone: Alternate Phone., 4/. �a z LW- eAe <br /> Contractor Information: <br /> Contrac or:• �! Contact Person: <br /> A4// <br /> ddress: 5r� State License#: <br /> City: Zip: Expiration Date: <br /> Phone: 9?A., �9�4.rJG� Alternate Phone: <br />