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M .• , ` <br /> FOR CITY USE ONLY <br /> Qitp City of Orono Date Received Permit ti <br /> �� ©, P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> 4 l ,:'04.0),/, Crystal Bay,MN 55323 <br /> +h 1;tft (952)249-4600 Approved By(If Required): <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 /> Residential(May Require Approval) p Commercial(Approval Required) <br /> pNew Connection ❑ Additional Connection ®Re-Connection EP Repairs 9 Disconnect O(1 <br /> `�JJ <br /> Job Site/Owner Information: <br /> V <br /> ' A / <br /> Site Address: al 9 Q . , W C1 <br /> WOOP Mailing Address: `f; Qt5' ? 6 7/O <br /> City: W � '� Zip: 5-5-3 <br /> / <br /> Home Phone: (a. Porkg `O$ Alternate Phone: :i C1/14 `e <br /> Contractor Information: <br /> Contractor: _ �L Contact Person: '74 t 6td56 <br /> Address: (, ( 3O) C 7,t1 State License#: <br /> City: VV dk Ul, II Zipc:ti99xpiration Date: <br /> Phone: i <br /> D (,' Alternate Phone: <br />