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-- �R C�USE ONLY— �7�, <br /> ����.��I�J,` City of Orono Date Receiv Permit#�-�Y/l�- <br /> t P.O.Box 66 <br /> � 2750 Kelley Pazkway ❑In-House SAC Determination Form Completed �� <br /> `�y� a ��' Crystal Bay,MN 55323 � � <br /> ����h..St`�"��j (952)249-4600/Fax(952)249-4616 Approved By{If Required): � I� � <br /> CITY OF ORONO-SEWER& WATER/GEN�RAL RMIT <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 aaalication is receivedl <br /> GENERAL INFORMATION <br /> 1. 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 wiil <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 /> �., <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑ Additional Connection �°�Connection ❑ Repairs �isconnect <br /> ❑ Water Availability Connec�ion For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: c� � ��� �.rw�-a-v� `�� <br /> Owner: �G,rv�.¢-�� ��-���G,�� Mailing Address: �'�75� �SICn,�,� U�e�;,� Qv <br /> c�ty: M°wh d z�p: S�3��' <br /> Home Phone: � �a - ? � I �� �� 9 Alternate Phone: <br /> Contractor Information: <br /> Contractor: (_r� l$o v�,.e�S Contact Person: �°� °�-�' <br /> Address: ���a-3 �r�,��,r' State License #: 1.3�.(v�� ��6 <br /> City: �mo�b�L, Zip:S�j���1 Expiration Date: 3/3 ��I�n <br /> Phone: ��'S�a" ��p�a Alternate Phone: <br />