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� <br /> FOR CITl'USE ONLY <br /> f�J(�"���\ City of Orono Date Received: Pcrmit# <br /> „O `�`Q�,; P O.Box 66 <br /> � �a tl 2750 Kelley Parkway ❑In-House SAC Determinat�on Form Completed <br /> ���1d ,l�`��- �� Crystal Bay,MN 55323 <br /> ���� r.,V,�G`� (952)249-4600 Approved By(If Required): <br /> ��; �oa;� <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 application 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. 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 ANI'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 � Disconneet <br /> Job Sife/ Owner Information: <br /> Site Address: � �UC� �.�c;S�� T��i�� ���: <br /> Owner: ,%�� v1 c, �a f�� Mailing Address: <br /> City: Zip: <br /> Nome Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: w� ✓��''` Y' �`� Contact Person: ��i-� ����-%�' � <br /> Address: �j�`�( �� ,�'c� (� State License #: 1��y/��''� <br /> City: �1r�t�"��C�� Zip:S� -�'YExpiration Date: ����3��C�� <br /> Phone: ��'TS-� I �7�' �g S7 Alternate Phone: �(O �a �`�� " � � � / <br />