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r ,. , <br /> � F R J,TY SE ONLY <br /> � ��� City of Orono Date Received:���(.' L'>�Yermit# ����2 <br /> P.O.Box G6 <br /> y ��,� � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> � ���y�.�� � Crystal Bay,MN 55323 <br /> ����.�o (952)249-4600 Approved By(If Required): <br /> saxo <br /> CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval Uy the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the application is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility perntits 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 busuiess days. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the pernut card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed contractars only. <br /> 6. Contact the Public Works Department(952-249-4600) for utility shzb 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 pemut 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 Ap ly) <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> �New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: ��� %�:<< �J��!' ��(' . <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: - � � ` <br /> ,�i Contact Person: (� r� <br /> Address: ���}( C.'Ci . ��-%�-L 1 S State License#: <br /> City: �Mt"?r���C"J Zip:`�����Expiration Date: <br /> Phone: (�`�� Y 7�- ��S��� Alternate Phone: <br />