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FOR CITY USE ONLY <br /> "J�,��\` City of Orono Date Received: Pennit# <br /> ;jOg `�`��" P.O.Box 66 <br /> � *+,,.;;., 4� 2750 Kelley Parkway ❑In-House SAC Detennination Form Completed <br /> ��� ij��,,�,- �� Crystal Bay,MT�'S5323 <br /> ��`�" r,r�*�,S`� (952)249-4600 Approved By(If Required): <br /> �t�o ` <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by thc Building Official and/or Public Works Departnent*) <br /> (ALL PERMITS- Mav be subiect to further review and mAv not be icsued when the aoulication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utiliry 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 ANl'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 I ) <br /> �Residential (May Require Approval) � Commercial(Approval Required) <br /> � New Connection � Additional Connection �Re-Connection � Repairs � Disconnect <br /> Job Site/Owner Information: <br /> ✓ �/ <br /> Site Address: �,` � �L� �� � /� � l'���C,1 � <br /> Owner: � L."�,L�� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> � <br /> Contractor: �'� Contact Person: <br /> Address:�� 5 �D Gv (� l/� State License #: �l Z `� <br /> -` C <br /> C�ty: � Zi��yUExpiration Date: � � �� d � <br /> Phone: ��� ��� �� Alternate Phone: ��� �J� � ��� C�/ � <br />