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FOR CITY USE ONLY <br /> '�(����\` City of Orono Date Received: Permit# <br /> /O� `�`0�;, P O.Boa 66 <br /> �� n; , � 2750 Iielley Pazkway ❑In-House SAC Determination Form Completed <br /> i�� �j`� � �� Crystal Ba}�,MN 55323 <br /> '���� << J,6E� (952)249-4600 Approved By(If Required): <br /> .� saso4:�% <br /> CITY OF ORONO— SEWER& WATER/GENERAL PERMIT <br /> (*Note:Somr_permits ma}'require approval by the Building Official and/or Public Works Department*) <br /> (ALL PF,RMITS- Mav be subiect to further review and mav not hc issued when the anplication ie 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 ANl'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 /> Job Site/ Owner Information: ��� ��` J`� , ,')� ��,� <br /> � C� l� <br /> Site Address: � c� � �//f/� � „��� <br /> � <br /> Owner:�` Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor:� �� °—l� �� � Contact Person: P �� <br /> Address:7 7� /�j����� State License #: � / � <br /> Ss j�`� � 3 � � <br /> City: ��� Zip. Expiration Date: l � <br /> Phone��0 � % � � � �/ �. Alternate Phone: ��/� J�/ �J O Z y� <br />