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81,_---0.‘—,'N\l Cityof Orono >l CITY ONLY <br /> Date Received: Permit# <br /> ; P.O.Box 66 <br /> 4 2750 Kelley Parkway O In-House SAC Determination Form Completed <br /> ,�J Crystal Bay,MN 55323 <br /> r <br /> Rt'A SHo¢�c1 (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> CITY OF ORONO-SEWER&WATER I 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 mot be issued when the annileation L 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 /> 4Residential(May Require Approval) 0 Commercial(Approval Required) <br /> IiNew Connection 0 Additional Connection 0 Re-Connection 0 Repairs 0 Disconnect <br /> 0 Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: o2 F4 g L/dbn J)leek 77_ , <br /> Owner: Mob 14701-4-y JdstS Mailing Address: <br /> City: ,401/1) Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ASA. ��� r/L /4k, Contact Person: /t7.1 490/4, 4 <br /> Address: 29/4 ,Eiit-A, State License#: <br /> City: 45%;46 Zip: 2 3 Expiration Date: <br /> Phone: 4.$7 4"8', /3$5' Alternate Phone: lQ/a, 91 f, /J+' <br />