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OZ- 7 9_5 <br /> FOR CITY USE ONLY <br /> fr.„¢04� City of Orono Date Received. Permit 4 <br /> P.O.Box 66 <br /> � >l ,h 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> \ x 14ya CI% (952)249/ Crystal -4600 y,MN 55323 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 /> p✓ Residential(May Require Approval) ❑Commercial(Approval Required) <br /> MI New Connection ❑Additional Connection In Re-Connection ❑Repairs In Disconnect <br /> Job Site/Owner Information: <br /> Site Address: 2095 WEBBER HILLS RD <br /> Owner: TOM SWEEN Mailing Address: 2095 WEBBER HILLS RD <br /> City: WAYZATA Zip: 55391 <br /> Home Phone: Alternate Phone: (612) 209-7177 <br /> Contractor Information <br /> Contractor: KOTHRADE SWE, INC. Contact Person: GLEN KOTHRADE <br /> Address: 12059 WHITETAIL LN State License#: MPCA 0192 <br /> City: HANOVER Zip:'5- I Expiration Date: 5/ai)Oi <br /> (763) 498-8702 (763) 286-8702 <br /> Phone: Alternate Phone: <br />