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r <br /> � • 4. <br /> .-- � FOR CITY USE ONLY <br /> -� `' City of Orono Date Received: Permit# <br /> ,-`���314�:� <br /> r <br /> '` ' P.O.Box 66 <br /> `'`g � 2750 Kelley Parkway ❑ln-House SAC Determination Form Completed <br /> \� F � Crystal Bay,MN 55323 <br /> `- � �'� �%� (952)249-4600/Fax(952)249-4616 Approved By(If Requued): <br /> ���r <br /> CITY OF ORONO— SEWER& WATER/ GENERAL PERMIT <br /> (*note:Some permits inay require approval by the Building Official and/or Public Works Depattment*) <br /> (ALL PERINITS- Ma��be subiect to further review and ma��not be issued w�hen the aoplication 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 A 1 ) <br /> `�Residential (May Require Approval) ❑Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection ❑Re-Connection Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hoo -Up to Water <br /> Job Site/Owner Information: <br /> Site Address: ���� �U��'S� l�c,b� J�✓ • <br /> Owner: !�;�, ������-� Mailing Address: �'�^'� <br /> City: ��U!�� Zip: 5�3(� �! <br /> Home Phone: '1J-�-- �"11� -S�l� Alternate Phone: �s1�^� - c���� �1�� <br /> Contractor Information: <br /> Contractor: - �v�'{'t� Contact Person: �l� ���� <br /> � <br /> Address: �� S S� c��� ��''��� State License#: <br /> City: �� Zip: �_�� Expiration Date: ���-�1"��"/ <br /> Phone: ���" SI��" 3�1D1 Alternate Phone: 7�'1��C� ���'(I <br />