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� . <br /> FO/R}CITY USE ONLY ��� <br /> City of Orono Date Aeceived:/�/i��,1'�mit# �/ ' <br /> 'Q'��' e.o.aoX�6 ��� <br /> >��_ . �'�'� 2750 Kelley Parkway ❑In-House SAC Determinatiuo Form Completed <br /> � ys'�' +.'i Crystal Bay,MN 55323 <br /> '����,�o�� (952)24J-4600 Approved By(If Required): <br /> \��os,f <br /> CITY OF ORONO–SEWER&WATER/GENERAL PERMIT <br /> (*Note:Somc pcnnits may rcquirc approval by thc Building Official and/or Public Works Dcpartmcnt*) <br /> (ALL PERMITS- Mav be subiect to(urther review and mav not be issued when the apnlicatinn 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 Yo Yhe 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 Publie 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 A 1 <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 Informarion: <br /> , <br /> Site Address: 1��� �T" ]��Zl����-�'��'. (.-- <br /> Owner: ��(Z l k /V��S���� Mailing Address: � ��`�� ��-1�.1Z��J� �1�'�% � <br /> ciry: �'��I/L t iL�L�l�r�l L���_ zip: �S �/ I �1 <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: j�l.}IZ/ll� ��'�c:��lll'��1%1�� Contact Person: �7�'U E., ���L(�l�-�. <br /> Address: 3�f��.) �C� IZC.� Z� State License#: �� �L- %�,, L�z <br /> ;S34c� <br /> Ciry: 1�-'1_����— Zip:�� Expiration Date: <br /> Phone: C ���z �S� -3/�Z Alternate Phone: C �P�� �1'�S _L� �>�, <br />