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PTWX 'KW \ v ) <br /> /9,1 Gu r/L____ <br /> FOR CITY USE ONLY <br /> /40 City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> i— 0&.\ <br /> 2750 Kelley Parkway El In-House SAC Determination Form Completed <br /> 41'4 t C Crystal Bay,MN 55323 <br /> a (952)2494600 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 /> I. 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 /> EXI,jZesidential(May Require Approval) 0 Commercial(Approval Required) <br /> New Connection ❑ Additional Connection .Re-Connection ® Repairs ❑Disconnect <br /> Job Site/Owner Information: <br /> Site Address: 13-3v <br /> Owner: .. 7r14. 1..1 Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: L.. A, . Contact Person: b31-1-1 <br /> Address: is to rrl I . State License#: <br /> City: = AG;•_._ Zip:Mid • Expiration Date: _ j t�L 6e) <br /> Phone: Alternate Phone: CIC1 'Z-(O <br />