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.� � <br /> � ., / <br /> � <br /> • FQ C1TY� E ONLY� (Tg" '� <br /> .-��tL��/�� City of Orono Date Receivecf� Pernut# �J��' o <br /> P.O.Box 66 <br /> Y ' 2750 Kelley Parkway ❑In-House SAC tetmination Form Completed <br /> � .- Crystal Bay,MN 55323 <br /> ; ��'� ti����� (952)249-4600/Fa�(952)249-�616 Approved By(If Required): <br /> -....:'_::- <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> ('Note:Some permits may require appro�al by the Building Official and/or Public Works Department") <br /> (ALL PERMITS- Matibe subiect to further review and mav not be issued when the application is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pernuts 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. 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 /> '�,Besidenrial(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection �e-Connection �airs ❑Disconnect <br /> ❑ Water Availability Con ectrC ion For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: Z q�� � Z��� �'_fl�.IN�� ;S�YL�T <br /> Owner:��� ���i.�L���Q S Mailing Address: �-�1� ��3.V'�Mf.I.V� �Y 2Q,� <br /> c�ri: C�ron � Z�p: 5539 I <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ����,,� Contact Person: �✓ <br /> , ��� <br /> Address: l�'��� C��.�,.�.�, ��-. State License#: �� <br /> � . 3� /� <br /> City: � Zip:��xpiration Date: �� <br /> Phone: C� `�i 3�i��� ��z 3 Alternate Phone: � r� `�� / ' �� � <br />