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FOR CITY USE ONLY <br /> / ��^/O City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> ! - ' 2750 Kelley Pukway ❑In-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> ',i r�,��� (952)249-4600/Fa�c(952)249-4616 Approved By(If Required): <br /> A�����iM <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERMIT <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 anplicadon is receivedl <br /> GENERAL INFORMATION <br /> 1. You may apply far 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. Pernut 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. Utility connection pernuts 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 reqnired. <br /> TYPE OF PERMIT <br /> Check All That A 1 <br /> �CYltesidential(May Require Approval) ❑Commercial(Approval Required) <br /> � —� <br /> �New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> SiteAddress: �`'',�� �a��-� ���� '` <br /> Owner: ��ne VV��LJ LLC Mailing Address: �S 3 l�.Q,�'�' ��C S�" <br /> c�Ty: IQ� ���7�i�}v� z�p: SS.��1 � <br /> HomePhone: �7�� ����� ���� AlternatePhone: ��� ���� ��� � <br /> Contractor Information: <br /> Contractor: ���� � ���5 Contact Person: � ��V ��� <br /> Address: ����� � �`� � State License#: � ��� <br /> City: 1 �1�15 Zip:�����Expiration Date: � � �� � �� <br /> Phone: �Sa�-��� �')��� Alternate Phone: ���' �� I � �J�d <br />