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FOR CITY USE ONLY <br /> (} City of Orono Date Received: Permit# <br /> 70t0; © P.O.Box 66 <br /> 2750 Kelley Parkway E In-House SAC Determination Form Completed <br /> `? x" ,,a. Crystal Bay,MN 55323 <br /> ji:t'•• (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 /> esidential(May Require Approval) in Commercial(Approval Required) <br /> ® New Connection ❑Additional Connection ®Re-Connection ®Repairs ❑ Disconnect <br /> Job Site/Owner Information <br /> ss <br /> Site Address: �90 %' Z p2 Al' <br /> Ownery , GU i� �,�, Mailing Address: 5 --,1--t, - <br /> City: Ay c/ / i77t4, Zip: ,53rd <br /> Home Phone: Alternate Phone: 7z,,6 -X 7 /G D <br /> Contractor Information: <br /> Contractor:OG✓� ( " Contact Person: of o! gr'4) <br /> Address:c25)✓L _ 's 4--' State License #: d '.S---0 <br /> r <br /> City: �° Zip 3 ' xpiration Date: <br /> Phone:0- 7f1' --f Alternate Phone: 6474 757 C J 6 7 "-'--� <br />