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� ' <br /> FOR CITY USE ONLY <br /> ��'-��l�� Clty of Orono Date Received: Permit# <br /> j � P.O.Box 66 <br /> � � »1 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> '��_ � • ] Crystal Bay,MN 55323 <br /> ` � -'�T''\ �� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> ��_' <br /> CITY OF ORONO- SEWER & WATER/GENERAL PERNIIT <br /> (*Note:Some permits may require approval by the Buildin�Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further revieN and mav not be issued when the apalication is received) <br /> GENERAL 1NFORMATION <br /> L 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 unril you receive a permit card. <br /> 4. Wark 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 A 1 ) <br /> 8'T�sidential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ��isconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: �"7� % <br /> Owner:�/S c�,��..�5��'1�I Obb'j� �7 Mailing Address: <br /> City: Zip: <br /> Home Phone: b I Z Z 7�� ���� I Alternate Phone: <br /> Contractar Information: <br /> � ` <br /> Contractor: �'R�`�"�. C��� Contact Person: ;T T�-�'►'` l` t'� <br /> -�— <br /> � �'�� <br /> Address: �.!7 I���.r,�eti�' \J'� State License#: �.�'���' S ��C� <br /> City: °�.� ��Q�- Zip:�����J Expiration Date: � + _ <br /> . <br /> Phone: l� �i � ��S ��7 � �- Alternate Phone: �( � ��s v` ����� <br />