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FOR CITY USE ONLY <br /> }it.DA/0 City of Orono Date Received: Permit <br /> P.O.Box 66 <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> 4.1*,_ <br /> ''t'r� �� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> l ettO <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 /> I. 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 ❑Re-ConnectionRepairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook- p to Water <br /> Job Site/Owner Information: <br /> Site Address: (0- 0C�'�.0 � ( 1 (ee� �� S 120C 4 <br /> r <br /> Owner: 't, 1' 0 _ Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: . , ��p C l-3 Contact Person: Ef(1 (4 C4✓ t' <br /> 656r __:(2,_ �f <br /> Address: CS State License #: <br /> City: Wet-e0-CI Zip:5c34xpiration Date: <br /> Phone: C j6, --47)-- (-(? S Alternate Phone: 6(-2-W/-9 77 J <br />