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RECEIVED <br /> MAR 0 9 2007 <br /> FOR CITY USE Of Y� O ORONO <br /> City of Orono Date Received: Penin <br /> /03.- 1�� P.O.Box 66 <br /> _ ,,h,,, 0'11 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> k °rf (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 5) <br /> (ALL PERMITS- May be subject 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 DI Repairs 0 Disconnect <br /> Job Site/Owner Information: <br /> Site Address: B//,.h / OA&tv Ia ek la <br /> Owner:SitVC, Codds1 Mailing Address: ROS f3ox / 7 $ <br /> City: Move /kw Zip: S.6."3 <br /> Home Phone(96.2) V74-6-136 Alternate Phone: <br /> Contractor Information: <br /> Contractor: L✓e ft,„It C. Se. </-0- Contact Person: Sr;An (/�• �'= <br /> Wviote,, <br /> Address: fico/ C4 /U.!• /( State License#: /'o V/0/11 <br /> City: Me v.oA Zip: 3c3ty Expiration Date: ./.2-3/-07 <br /> Phone: 9.C.4,2- Y9?- VICC Alternate Phone: 6/2 -7 "// - 977? <br />