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P'0�2 CITY LiSL ONI.1' (�' <br /> /:�0"� City Of Orono Date Rcceived:�" �U� Pcnnit# �/�7Q � <br /> /, � ����� P.O.Bo�66 <br /> 1,�,, �\i� 27�0 Kelley Parkway ❑In-House SAC Detennination Form Completed <br /> �� i�``'�� �*�� Crystal Bay,MN»323 <br /> ��s ��, �r c! (9>2)249-4600 Approved By([f Requircd): <br /> \`�''kFax��E' <br /> C1TY OF ORONO—SCW�R & WATER/GEN�RAL P�RMIT <br /> ('`Note Somc permits inay requirc approvll bv thc[3uildin�O1�Cicial and/or Public Works Depnrtincnt*) <br /> (ALL PfR14I7'S- biav bc subicct to ftn'thcr rc��iew�ind m;rv not be issuctl�ti-hen Ihc o-�nqlication is rccciced) <br /> GENERAL 1NFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mai(ed in applications are subject to the�ostage and handlin� fee sho�vn belo��. Permit cards���ill <br /> be sent by return mail �vithin 2 business days. <br /> 3. Permits�re not valid �uitil you receive a permit c�rd. <br /> �i. Work must not begin unless the pertnit card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> � � 6. Contact the Public �Vorks Departil�ent(952-249-4600)for utility shib as-built locations. <br /> DO \'O"T E\CAVA7'E IN ANY STR�ET AND ll0 NOT 7'AP ANl' 1�'If1IN withoirt express <br /> approv�l of the Public �Vo�9cs Department Issuancc of a permit does not grant this approval. <br /> 7. All work must bc done in accocdance with State Code requirements. <br /> 3. All �vorl:must be inspected before it is covered. Call(952)2�9-=�600,24+how�notice required. <br /> TYPC OF PERNIIT <br /> (Check All That Apply) <br /> �Residential(May Require Approval) � Commercial (Approral Required) <br /> �, New Connection � Additional Connection �Re-Connection �� Repairs C] Disconnect <br /> Job Site/Owner Infor►nation: I <br /> Site Addcess: c�o2 �,j ��u-yu>-v �l <br /> O���ner: U�C �77r�=-5 ivlailin� Address: <br /> City: 7ip: <br /> Home Phone: 1\Iternate Phone: <br /> Contractor Information: <br /> Contractor: }�'�2.��10-v� /�C� Contict Person: �c <br /> Acldress: / / State Liceilse +: �—�0��Z <br /> City: �i1/�it-���� _7,ip: 5��'E�pil-ation Date: <br /> Phone: �ola 363 �1��' rllternite Phonc: <br />