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/ FOR CrrY USE ONLY <br /> �y 01�IO� City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completed ' <br /> y� Crystal Bay,MN 55323 <br /> (952)249 4600 Approved By(If Required): <br /> \e `/` <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 PERMITS- May be subject to further 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 /> VqResidential(May Require Approval) E:1 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: 760 <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> S <br /> Contractor: ���cry vs4 rip<✓rfi�P�l i c <br /> l Contact Person: /Pjg ((s <br /> Address: 5C/5_° 2 2 f j9 v(-.:^WLO State License#: <br /> City: Zip:^/-` Expiration Date: <br /> Phone: [��Z' 3�� ^ 7�00 Alternate Phone: <br />