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� � , <br /> � FOR C[TY L'SE ONLY <br /> ¢Q,�` City of Orono Date Received: Permit# <br /> `r P.O.Box 66 <br /> �"� � 2750 Kelley Parkway ❑ In-House SAC Determination Form Completed <br /> a ��� � Crystal Bay,MN 55323 <br /> �+� � �` ��i�o o (952)249-4600 Approved By(If Required): <br /> �asso$` <br /> CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT <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 application is received) <br /> GENERAL INFORMATION <br /> L You may apply for utility pernuts 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 pernuts 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 pernut 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-Connecrion ❑Repairs ❑Disconnect <br /> Job Site/ Owner Information: <br /> � �� <br /> Site Address: ) � ' �s2 �2 � <br /> Owner: C%L1 G i��`� Mailin Address: <br /> Jc- �i g <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> ,�-� 1 � � � � <br /> Contractor��--����"� `� �`�'� �� Contact Person: � <br /> Address: � � (�C�� ��� State License#: ����� _ <br /> City: �=�/,� Zip:�s�/ �xpiration Date: J `- � �� <br /> Phone: �� � , 7� � �/� Alternate Phone: (� ` � �� C/� <br />