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FOR CTI'Y USE ONLY <br /> .1(���/�/�-J City of Orono Date Receive3: Pernut#� <br /> P.O.Box 66 <br /> \� 2750 Kelley Pazkway ❑In-House SAC DeterniinaUon Form Completed <br /> �� , . Crystal Bay,MN 55323 <br /> •�'1 (952)249-46U0/Fax(952)249-4616 Approved By(If Reyuired): <br /> CI'I'Y OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> ("Note:Some permits may require approval by the Building Official and/or Public Works I)epartment') <br /> (ALL PERNIITS- 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 urility 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. Urility 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. lssuance 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 no6ce 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 /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: �4� (� �-`�"""`�� S�{-�-� <br /> Owner:� J�v�S Mailing Address: <br /> City: �►rd�"�O Zip: <br /> Home Phone: �n�Z • 7�� ° 9� 27 Alternate Phone: <br /> Contractor Information: <br /> Contractor: Contact Person: <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br />