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. ��+ 1 <br /> ' FOR C TY U,.E ONLY .,�.^� ��"' <br /> i�.-0/1T \ City or Orono Date Received: � ermit# � 1;'�' � <br /> 1 � 'ti P.O.Box 66 �-� <br /> I ( � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> ; ; � ;' C stal Ba ,MN 55323 <br /> �Y Y / <br /> `y``���¢F�j (952)249-4600/Fa�t(952)249-4616 Approved By(If Required): /�, �.�`(� <br /> �..kES.H` .`"� G J \ <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT ��i <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) � <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the auolicallon is received) <br /> GENER.AL 1NFORMATION <br /> 1. You may apply for utility permits by maii or in person at the City of�ices. <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 Deparnnent(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 /> approvai 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 ❑ Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: /�G � (�a L���� � f � � (� /�o cz � <br /> Owner: �T��� �l�«�'t Mailing Address: ��d?-� �oc Lc,.�u l� ��fi!C !� <br /> City: �i�_,t� O Zip: <br /> ,� <br /> Home Phone: �J Z Z f-U�?�� Alternate Phone: <br /> Contractor Information: <br /> Contractor: � F���-t� /l� Contact Person: ��e-� �P�.�P�,C/.9 <br /> �zl�o���� �U� � <br /> Address: ?� State License#: /���� 2,�`��'2 <br /> City: ���� Zip•t'� ��/�kpiration Date: �j. O�! � 2 �O� � <br /> Phone: �( 2 - 2�`�. �3 f 7 Alternate Phone: <br />