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r ,�' a <br /> FOR CITY USE ONLY <br /> ��� Ctty of Orono Date Received: Permit# <br /> O O P.O.Box 66 <br /> ; �,y� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> '�� �'�'�;���- ti Crystal Bay,MN 55323 <br /> ���^ ��?�c�a��h o~ (952)249-4600 Approved By(If Required): <br /> �4`��� <br /> CITY OF ORONO —SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Officiai and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoplication 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 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 nof valid until you receive a permit card. <br /> 4. Wark must not begin unless the pernut card is available on the job site. <br /> 5. Utility connection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Deparrinent(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 pernut does not grant this approval. <br /> 7. All work must be done in accardance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600,24+hour notiee required. <br /> TYPE OF PERMIT <br /> (Check All That Apply) <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connecrion ❑Additional Connection �.Re-Connection ❑ Repairs ❑Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: '�i'�� C�.e�nj �/��� <br /> Owner: � �,���I��,�.��.�,,,r,s' Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: Sc-��- � � L �C Contact Person: C�� l a� a�a,���./�� <br /> Address: /I�(I S v-���e,_ l7,f State License#: Yj ���J�' �� <br /> City: /Zo�c'I'.f Zip:�'�' 7c�xpiration Date: ��— G � <br /> Phone: ��a-a�a'��(�� Alternate Phone: �� � - ��7 —7 ((�a <br />