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6 � <br /> FOR C[TY USE ONLY <br /> 0 City of Orono Date Received: Permit# <br /> ¢ � P.O.Box 66 �� � <br /> ��;,v,,,. � 2750 Kelley Park�vay ❑In-House SAC Determination Form Completed � � '1� <br /> a ji��,�� � Crystal[3ay,MN 55323 , � 2�� <br /> �� q�� ��o o` (952)249-4600 Approved By(If Required): ��� <br /> t t�i�'�$v <br /> Mr�Ho <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- May be subiect to[urther review and mav nat be issued when the application is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pennits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will <br /> be sent by rehun mail within 2 business days. <br /> 3. Permits are not valid until you receive a pernut card. <br /> 4. Work must not begin unless the pennit card is available on the job site. <br /> 5. Utility connection pemuts may be issued to licensed conhactors only. <br /> 6. Contact the Public Works Deparinlent(952-249-4600)for utility stub as-built locations. <br /> DO NOT EXCAVATE Il\'ANY STREET AND DO NOT TAP ANY MAIN�vithout express <br /> approval of the Public VVorks Department. Issuance of a pernut 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 /> 0'1�esidential(May Require Approval) ❑ Conunercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection ❑Re-Connection ❑Repairs [`��isconnect <br /> Job Site/ Owner Information: <br /> Site Address: ��� �T r t <br /> Owner: �/�' � U� t�--`,'i1� ) Mailing Address: <br /> City: Zip: <br /> Home Phone: Altemate Phone: <br /> Contractar Information: <br /> Contractor: ��'St���- Contact Person: `- l � <br /> Address: �S�1 �� �L� � �` State License#: 1 (�� -1 �� . <br /> City: �U� Zip:553��Expiration Date: /� � � t- �' � <br /> Phone: �I S Z- �7 L_ `I �l'�(O Alternate Phone: � �Z- �� � ~ Y�� ( <br />