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. ' <br /> /�S � <br /> F C USE ONLY�v� !.J'S <br /> �-�/1/� City of Orono Date Received. L Permit# �' � � <br /> P.O. Box 66 <br /> 1 27�0 Kelley Parkway ❑ [n-House SAC Determination Form Completed <br /> i i , Crystal Bay,MN��323 <br /> �'.,�Y� F�� (9�2)249-4600/Fax(952)2d9-4616 Approved By(If Required): <br /> K.sri��� <br /> CITY OF ORONO — SEWER & WATER/ GENERAL PERMIT <br /> (*Note:Some pennits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PER�IITS- N(av bc subject to further review and mav not be issued when the apn�ication 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 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 Apply) <br /> �sidential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs �i'�onnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: �`17� ���-�o �• <br /> Owner: �C� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: � -.5.j�l_ �,�(ti� . Contact Person: � � � �'►^n'�' <br /> Address: (��1 6 ���id-�M� State License #: �02-�7 `�£' <br /> City: ' Zip: Expiration Date: <br /> Phone: Co 5 I— ���O—I 3S� Alternate Phone: � �������'y 3�� <br />