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• EOR CITY USE ONLY <br /> ��� City of Orono DateReceived: . Permit# <br /> P.O.Box 66 <br /> ��;; � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> a 'I�V������ � Crystal Bay,MN 55323 <br /> �� �' � '`• o~ (952 249-4600 Approved By(If Required): <br /> t,1��4?I���. ) <br /> CITY OF ORONO —S�WER & WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by Uie Building Ofticial and/or Public Works Department*) <br /> (ALL PERMiTS- Ntav be subiect to further review and mav not be issued when the ann��cation is received) <br /> GENERAL INFORMATION <br /> 1. You may appiy for utility pennits by mail or in person at the City offices. <br /> 2. Mailed in applicarions are subject to the postage and handling fee shown below. Pernut cards will <br /> be sent by rehn-n mail�vithin 2 busuiess days. <br /> 3. Permits are not valid until you receive a pernut card. <br /> 4. Work must not begin unless the peinut card is available on the job site. <br /> 5. Utility coiulection permits may be issued to licensed conh-actors only. <br /> 6. Contact the Public Works Department(952-249-4600) for utility shtb as-built locations. <br /> DO NOT EXCAVATE II�ANY STREET AND DO NOT TAP ANY MAIN w�ithout express <br /> approval of the Public Works Department. Issuance of a pernut does not grant this approval. <br /> 7. All work must be done in accordance with State Code requuements. <br /> 8. All work inust be inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> TYPE OF PERMIT <br /> (Check All That APPIY) ' <br /> �,Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Conneerion ❑Re-Connection ❑ Repairs �isconnect <br /> Job Site/ Owner vlformation: <br /> Site Address: � l �� �Cr�V�� ��I r�- ►'ti� <br /> 1 � <br /> Owner:l./� «C dM(�� Mailing Address: <br /> City: Zip: <br /> Home Phone: Altemate Phone: <br /> Contractor Information: ��.�� ,���1 <br /> � � roJ; f IG � �JQ� � �/�I Pr Contact Person: I �Fr� R l�- ������1 _I <br /> Contractor. � � JP � � ` <br /> Address: ���� Cbv'��'� �� 1 G State License#: <br /> City: ���ti�'�� 1���� Zip:"J�3� 1Expiratioi�Date: <br /> Phone: l� �7� " 1 �G� Alternate Phone: <br />