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�• , <br /> E <br /> i <br /> -�"`�� F�R C[TY USE ONLY � <br /> i ���0\ City of Orono Date Receive�]�_kj-�Pennit#C_��� �,' <br /> ` P.O.Box 66 <br /> � � 2750 Kelley Parkway ❑[n-House SAC Determination Fonn Completed <br /> �l <br /> Crystal Bay,MN>53?3 <br /> ��`,'"�,�kX s ��E�j�� (952)249-4600/Fax(9�2)249-4616 Approved By(tf Reqoired): <br /> CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the E3uilding Official and/or Public Works Deparhnent*) <br /> (ALL PERNIITS- Mav be subicct to further review and mav not be issued when the aoolication is received) <br /> GENERAL INFORMATION <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 thejob 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-buih locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without ezpress <br /> approval of the Public Works Departmeat. 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 A 1 <br /> � Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> a <br /> ❑New Connection ❑Additional Connection ❑ Re-Connection ❑ Repairs [� Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Wate�� <br /> Job Site/Owner Information: <br /> R <br /> � <br /> Site Address: �� � � �r �h�f��� ��' ��,�/�.L!Q <br /> Owner:�\V � � G,��d ��V�A� Mailing Address: ��y� �� ,�S �4�1-f�� <br /> c�ry: �(�I�. z�p: � ���� �� <br /> r� -- , <br /> Home Phone: ������ � � � �� Alternate Phone: <br /> Contractor Information: <br /> � �,�,,�,� . <br /> � � � a' � � ��!����, <br /> Contractor: � ��� U��� ° � ���Contact Person: <br /> � /s�, Vv' <br /> �f � I�C� D� �9��- <br /> Address: � � !� (il, �'"� State License#: <br /> City: �.�iQ Zip:�� Expiration Date: � 0 � <br /> _ ➢ <br /> Phone: � � �� ' � Alternate Phone: � � � ��� � <br /> ��� � ���- � � � d <br />