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� '•. <br /> �r--_ <br /> Foa crrv usE o�Lv <br /> Clt of Orono Date Rcccived: Pcnnit# <br /> �� Q� Y <br /> �4 � � P.o.BoX��> <br /> ���>� ��� 2750 Kellcy Park���uy ❑In-I Iouse SAC Detcnnination Form Complcted <br /> � p�+ p y II Crystal I3ay,MN�i323 <br /> �� � , o�� (952)249-4G00 Approved By(If Required): <br /> ��ehaaxoa�%' <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�tI"fS- �1a��be subiect to further review and mav not be issued when the annlication 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 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�vithout express <br /> approval of'the Public Works Department. Issuai�ce 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 /> %� <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: � � 7('' �1��.�y %l <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Conhactor: ��� /�/tk�1� � Contact Person: <br /> Address: ��� L�y_ 0�� 3 7 State License #: <br /> h. <br /> City: J�1� j . � � Zip: '� �3��Expiration Date: <br /> Phone: 3 ZC7-- �J b 3 -2Yc'� Alternate Phone: <br />