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� <br /> . -����- � FQR CI Y L1SE ONLY ¢ <br /> '��1 l�% City Of Orono Date Received:��� a�� Permit# l —d 0�p � <br /> a \ P.O.Box 66 <br /> � 2750 Kelley Parkway ❑ In-fiouse SAC Det�rniination Porm Completed <br /> 1 <br /> ��y �� ��� Crystal Bay,MN 5�323 <br /> �``�t ��� (952)249-4600 Approved By Qf 2equired): <br /> \.,�1KJ�c'rt�t� ," . <br /> CITY OF ORONO— SEWER & W ATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the I3uilding Oflicial and/or Public Works Department*) <br /> (ALL PERMI"I'S- �4av be subiect to further review and mav not be issued when the annlication 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. [ssuance 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 /> [�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 Water <br /> Job Site / Owner Information: <br /> Site Address: � `� I C �Uo(j"l� f�i� <br /> Owner: In'��<t` /.T`��5 � Mailing Address: �50 Z 5�`� /-��-+'� <br /> city: 5 1 ���v���� zip: s�6 3 0 3 <br /> Home Phone: ✓��- �� � ��`' ���� Alternate Phone: <br /> � Contractor Information: <br /> Contractor: �+�u 5 ��"��� Contact Person: �� � <br /> ���y <br /> Address: � �`�S�' �� �� �'� '�f State License #: aL Zo 1 �, `i �, S� <br /> City: � �`�- Zip: �'� Expiration Date: �`� �� `� <br /> Phone: �� � �� � ����`�� Alternate Phone: ��3 ��� � � �� � � <br />