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• . ' <br /> ' <br /> FOR CITY USE ONLY <br /> City of Orono Date Received: Permit# <br /> /0 " O P.O.Box 66 <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> P`* ; t Crystal Bay,MN 55323 <br /> \+IyE (952)249-4600 Approved By(If Required): <br /> Ri <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) 'Commercial(Approval Required) <br /> 04 New Connection ❑Additional Connection in Re-Connection ®Repairs ® Disconnect CC-) <br /> Job Site/Owner Information: /'( <br /> Site Address: c-) 6 0 k), W /Aid l,�'(` IT `�`' <br /> Owner: g,4 bey-- W hoc LL-- Mailing Address: p & s 70 <br /> City: b./0.11/--e Zip: �_5 3F / <br /> l <br /> Home Phone: (L CbG Alternate Phone: G � <br /> Contractor Information: <br /> Contractor: c�� pr � ��� Contact Person: 0A <br /> Address: PO 8 i 62) State License#: <br /> ------City: Zip:--T3? <br /> Expiration Date: <br /> Phone: l Z 1202- qJ Os-- Alternate Phone: Li't <br />