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+s, <br /> • <br /> ItOA CITY ONLY <br /> gO.A City of Orono Date Received: �;-/((-J$ permit sl„20t$-ciC tl�I <br /> P.O.Box 66 <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> s 2-f Crystal Bay,MN 55323 <br /> tt\IIP <br /> e (952)249-4600/Fax(952)249-4616 Approved By(IfRequired): <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 subiect 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 /> 0 Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> New Connection 0 Additional Connection 0 Re-Connection 0 Repairs ❑Disconnect <br /> 0 Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 64 Zd ebl) L)y c r . <br /> Owner: MV/) VL h Lt j, MA is Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: i Si11. A'U91//9`1"41 /W Contact Person: Mi kE ZdC..G//2--v <br /> Address: 294 41,71 ,¢, /9kE. State License#: <br /> City: /4347%,4,5 Zip: em93 Expiration Date: <br /> Phone: 4eS' 14d, /93-z— Alternate Phone: 6'47, 91'. '.1�/i" <br />