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Y <br /> • <br /> FOR CITY USE ONLY <br /> O �� Ci of Orono Date Received: Permit# Z O <br /> � s ty <br /> �' P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> '` .4N\i, I. /-/� Crystal Bay,MN 55323 <br /> \°���' \��.�j (952)249-4600/Fax(952)249-4616 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) ❑Commercial(Approval Required) <br /> 0,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: 3 O so CA12`e. he 1' `.its <br /> Roe <br /> Owner: �.�4-f2.i R'-V\- Mailing Address: .7 0`xC) c-0 ebbe; V.:OS t <br /> City: CT Of\D Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: C \S R t-[c \ Contact Person: C V f' t <br /> Address: /( 5 c1 Co' State License#: BZW Lt c_\ 1d07) <br /> City: DQ ) Zip: m/N Expiration Date: •De c _ `7 o`\ <br /> Phone: \Z7-61 el-M L:3"Z, Alternate Phone: <br />