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- - �a�. � <br /> /;..-�-..... FO TY S NLY� 1 �/-�/�/ <br /> � �. /,/O� City of Orono Date Received: �ermit# � C� <br /> , P.O.Box 66 <br /> ' 2750 Kelley Pazkway ❑In-House SAC Determination Form Completed <br /> y � Crystal Bay,MN 55323 <br /> ,`\�' �^ �ti%; <br /> H X;i \ � !� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> . dtstfoe. . <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 1NFORMATION <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 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 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: ��U� •��d�,1n/ �d. <br /> Owner: G'f1�C'is /��Ox'Td,✓ //1��5 Mailing Address: <br /> City: ��yiYl G�-7�� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: J���,M. ��i9t/A�N� �Nc, Contact Person: �/�i�� �'�/n�^'� <br /> Address: 29/��St,�� State License#: <br /> City: R.a`J��✓b 5 Zip:��'4�,3 Expiration Date: <br /> Phone: �i�%� y�a�13� Alternate Phone: <br />