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.� i�'" <br /> ��� <br /> � <br /> _ FOR CITY iJSE ONLY �� <br /> '"�p��� City of Orono Date Received: Pennit# �� <br /> ��'¢' �V �\ <br /> ,i O (���; P O Box 66 �� _,�Q� <br /> � �;, �I 2750 I�elley Parkway ❑In-House SAC Determination Form Completed �� <br /> �� i�� �'-r�'�. �� Crystal Bay,MN 55323 <br /> '�ld��`.rr��i,�G`� (952)249-4600 Approved By(If Required): � <br /> :���oA/' \� <br /> CITY OF ORONO-SEWER & WATER/GENERAL PERMIT p �,,�� �'" <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) A��,(\V`1'�� <br /> (ALL I'ERMITS- Mav be subiect to further review and mav not be iScued when the auplicAtion is received) �v <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 uniess 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. 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 Q Additional Connection �e-Connection [[]] Repairs � Disconnect <br /> Job Site/Owner Information: <br /> ` I � <br /> Site Address: ��� / ��f�l�v� S , ��� v�`f 1�� -. <br /> Owner: ' ��� <br /> �l� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> `._.-_--� ,._-._� <br /> Contractor: �.5. J7L�r9�j��Contact Person: :�5,5 c��l��-� <br /> Address: l�o�J ��q-r�u a� �,1� State License #: �Oc�C� <br /> � <br /> City: �Y?���'�i'�- Zip: ���3�i� Expiration Date: <br /> Phone: ��3-�/��1` �%0 3� Alternate Phone: �v��-7j���-5��,� <br />