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, .. <br /> FOR CITY USE ONLY <br /> ,�0� Clty of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> ��,, � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> 'a � �;� F Crystal Bay,MN 55323 <br /> ��t-���r�o o` (952)249-4600 Approved By(If Required): <br /> �A�g08$ <br /> CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Bui]ding Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aonlication 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. Pernut 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 Pubtic 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 ❑ Re-Connection ❑ Repairs �isconnect <br /> � \ <br /> Job Site/ Owner Information: <br /> Site Address: c��aC;r' ---�� C'��� �, �� �;:.�,�� <br /> ,4„ _ ` �,.�d �n <br /> Owner: ��,.ra- ��� .. � Mailing Address: <br /> � <br /> City: �rp a�a � � Zip: S���i � <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> � <br /> ,� -' ,� ., ....,,K <br /> Contractor: �`� ' �.�. ''✓ � 1 !' � �':�'. Contact Person: ��.�",� ..�..� <br /> Address: ,���.��'",� :::�`.��'r"`���,��/�s`'Y', State License #: ��� '"6��� <br /> � <br /> City: ���,,,�°,,��f`,;� Zip: `���`�'�Expiration Date: ���'�',� �',� <br /> , � <br /> � , , <br /> � <br /> Phone: �",�r,� °� ;d�'''° • � ��`�;%. Alternate Phone:C�±f ��� � <br /> , , 6 � �..�',��.� <br />