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, <br /> FOR�OSE ONLY ����0 ��j � <br /> � City of Orono <br /> Date�Keceived:7 Permit# 02. <br /> �//�'��O` P0. E3oz66 <br /> Y� '� 2ti0 Kelley Park�.�ay ❑In-House SAC Determination Form Completed <br /> ;�a y�� 7�, . �;.' Crystal Bay,hf\5�323 <br /> ��A�;,�: �,yu`,/ (952)249-4600 Approved By(If Required): <br /> ,`��` <br /> CITY OF ORONO—SEWER & `�'ATER/ GENERAL PERi�IIT <br /> (*Note� Some permits may requice approvaf by the Building Official and/or Public Works Department*) <br /> (ALL PER�IITS- �iav be sub'ect to further review and mav not be issued when the a lication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utiliry 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 untit 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 NIAIN without express <br /> approval of the Public��'orks Department. Issuance of a permit does not grant this approval. <br /> 7. All�vork must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call(952)2d9-4600,24+hour notice required. <br /> TYPE OF PERI�IIT <br /> (Check All That A lv <br /> � Residential(Ivlay Require Approval) � Commercial(Approval Required) <br /> [�New Connection ❑ Additional Connection ❑Re-Connection ❑ Repairs �Disconnect <br /> Job Site/ Owner Information: ���� �� � � � <br /> Site Address: �� � t ��C� �� r� �� <br /> Owner: �����,��—.�-- I�lailing Address: <br /> City: _�r���— Zip: <br /> Hame Phone: Alternate Phone: <br /> Contractor Information: � / <br /> COl1C r�2 t5�. !�.h�-�._, �'�t; �G�'1--� <br /> Contractor: Contact Person: <br /> '1,��� C'c�mtti,� ��. <br /> r ''�.- <br /> Address: State License #: <br /> sS��� �z -3 � - ��i <br /> Cit ��rC�r�"� Zlp: Expiration Date: <br /> Y� <br /> Phone: ���� ' �2-��'�-�� Alternate Phone: 1!�� Z-' ��� r a� � � <br />