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, w <br /> t <br /> FOR CITY USE ONI,Y <br /> ;¢0� City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> ����. � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �� �`'��• t�� Crystal Bay,MN 55323 <br /> �+,a�,y�e� (952)249-4600 Approved By([fRequired): <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 PERMITS- Mav be subiect to furt6er review and mav not be issued when the annlicatioo is received) <br /> GENERAL INFORMATION <br /> L 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 iicensed 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 1�TOT 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 /> �'�esidential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑New Connecrion ❑Additional Connection �'1Fe-Connection ❑Repairs �Disconnect <br /> Job Site/Owner Information: <br /> Site Address: �� � ? �" �'c " '�o ;.� f �'`/ <br /> Owner: � "�`' ��'` �a �<l �` Mailing Address: ��� 3 �" '"' �`'"� � '�`� <br /> City: Or� , � Zip: <br /> f'�// o�� - cv v 7 7 <br /> Home Phone: Alternate Phone: �� � -� <br /> Contractor Information: <br /> Contractor: �� v' � � �X�"v`j ����Contact Person: �"�`�`� �4 `lG'� <br /> ��35" Y'nnJ� 'ic:.�'�r. <br /> Address: f�"r �! State License#: <br /> �sv?� <br /> City: Cr�' ��' � Zip: Expiration Date: <br /> Phone: �� ''""' �s - �5 � � Alternate Phone: ���" �"s -�� "3 3 <br /> �C �-, �� Cr!! <br />