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FOR CTI'Y USE ONLY <br /> O¢O�O City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> `�� �,`'�• �, Crystal Bay,MN 55323 <br /> '�t�'%,�.�c,, (952)249-4600 Approved By(If Required): <br /> .,'rt�o� <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (•Nott:Some permits may require approval by the Building Officiai and/or Public Works Department') <br /> fA�LL PERMITS- Mav be subiect to fart6er review and mav not be issued when t6e anolication is receivedl <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 hy 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 o�ly. <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 Pablic 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-Cannection ❑Repairs �Disconnect <br /> Job Site/Owner Information: <br /> Site Address: � 6 � 3 c �- �c � �a , ,., f ��� �,/ �� <br /> � w i 1l n.-t��i�c t e� <br /> � V� /�Gr. .�7 Gt /� /�' ,,,7 6 7 � CGi r�o �G r-r 7� /[ o t<<I <br /> Owner: Mailing Address: <br /> City: �� "'' G Zip: <br /> f��::-f: Cr�i <br /> �sn�e-Phone: 6��- a� 7" y i �s Alternate Phone: ���- �� �- � � �� <br /> Contractor Information: <br /> Contractor: /�r "' �� �X�� `�� �''�y Contact Person: l. �'`Y�� V' �� � <br /> �3 � 3r <br /> Address: �{�y f y����-'� ��r ,y State License#: <br /> City: ���f f� � Zip:sry 7 7 Expiration Date: <br /> CY�� v s- 3 3n .s <br /> Phone: 76 :�--s-s�r- � S-s-� Alternate Phone: 6� �- � <br />