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• <br /> • <br /> I <br /> • <br /> FOR CITY USE ONLY <br /> p� City of Orono Date Received: Permit# <br /> o Q\ P.O.Box 66 <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> 14. Crystal Bay,MN 55323 <br /> t ^+� o (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 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 /> ® Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ® New Connection ❑Additional Connection 8 Re-Connection ®Repairs KDisconnect <br /> Job Site/Owner Information: <br /> Site Address: /3 o �heicri P��e e <br /> Owner: j,ri ( 14nfC,1 Mailing Address: 6 636 f b Liae/ ,-4.1- 41/,i.,„(2-- <br /> City: i'/ic ✓ Lb /e Zip: 55- vZ <br /> Home Phone: 6(5z- 47- 7--wo ?4 Alternate Phone: (a(Z - ,A0— &49 7- <br /> Contractor Information: q <br /> Contractor: ..,.11 .b.);4 Co -i Contact Person: (/1 v c A 1q <br /> Address: 1530 j21jo'�'jt 6f (A State License#: c;?' .`19 <br /> City: OU'd PUt Zip: CiO(Expiration Date: J/u - <br /> Phone: q52_-- . 4T5- 108 Alternate Phone: <br />