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� ' - � ,y� <br /> ��� v(/ <br /> FOR CITY USE ONLY ���[� � <br /> /-y�� City�of Orono Date Received: Permit# �y�L�/�—L <br /> �r "'�� P.O.Box 66 <br /> � �[ � 2750 f:elley Pazkway ❑in-House SAC Determination Form Completed <br /> j' �� � ,�, � � Crystal Bay,MN 55323 <br /> ` '� '�`'�: w� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> � ��,��;��"; <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 PERMITfi- Mav be subiect to further review and ma� not be issued when the aaplicatiun 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. 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 /> �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 Wate� <br /> Job Site/Owner Information: <br /> �' G /�' <br /> �� � � <br /> Site Adciress: �� o � /�``,C� C ��� P <br /> Owner:��'� ����C� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ��5�°� `�" ��z"'J Contact Person: '��1 �c'�' �I <br /> Address: ��� �� ��� ( � State License#: <br /> City: ��� Zip:���xpiration Date: �.���� �-- / � <br /> Phone: ��-� ^��-Z- �S � Alternate Phone: V� �—7���� 7 �S <br />