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�"^�' FOit C�'Y�USE ONLY <br /> ,������ City of Orono Date Received: ���I �i�# '.� (��� <br /> ; P.O.Box 66 � <br /> i j 2750 Kelley Parkway ❑In-House SAC Determination Form Completed `�(r/ <br /> i y� V�� Crystal Bay,MN 55323 <br /> \\���¢� (952)249-4600/Fax(952)249-4616 Approved By(IfRequired): _ ,`�i`�'� <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Depaztrnent*) <br /> (ALL PERMTI'S- Mav be subiect to turt6er review and mav not be issued w6en the aoulicallon is rceeivedl <br /> GENERAL INFORA�ATION <br /> 1. You may apply for urility 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 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 A 1 <br /> ❑Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> �New Connection ❑Additional Connection �Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner in#'o�mation: <br /> Site Address: S � ��� �-�/`��`� ! � �i n <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contrac�or Information: <br /> Contractor: ?�� ���' � , ��� Contact Person: ��'� ��p �rt Z- <br /> Address: �C `�� �'--,�?�(,//1 T� State License#: <br /> v <br /> City: �-h�"��= Zip: S�3'3 Expiration Date: <br /> Phone: < < � -� ������� Alternate Phone: <br />