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FOR CITY USE ONLY <br /> Q� City of Orono Date Received: Permit# <br /> �� ��� P.O.Box 66 <br /> +��' ��� 2750 Kelle Parkwa <br /> �+,� y y ❑In-House SAC Determination Form Completed <br /> ��: �r,>. � Crystal Bay,MN 55323 <br /> ,��''�x��j a�•y�/ (952)249-4600 Approved By([f Required): <br /> �`��; <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 aan��cation is received) <br /> GENERAL INFORMATION <br /> L You may apply for utiliry 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 wark 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) � Commercia((Approval Required) <br /> � New Connection �Additional Connection �Re-Connection �Repairs ❑ Disconnect <br /> Job Site/Owner Information: <br /> Site Address: ' �'� `�%� �/��/��YL �� � <br /> Owner: ��� SC�jti L �Z Mailing Address: =Sc-z-�.---�_ <br /> City: l./��✓��'� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: �� <br /> c . J ,, <br /> Contractor: _ I/'Q'Vt�('� �����ontact Person: ��"'� .��� �f� <br /> �// � 1 � <br /> Address: ,UC/ O��/�� t��'t-�1�U-�tate License #: ��j � <br /> City: ���� /«/� ✓iC� Zip:���Expiration Date: �� � l ' �� <br /> Phone: ��Z���^�/�/ Alternate Phone: / �Z D 7��3�1 L� <br />