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� FOR CITY USE ONLY � � <br /> O40 p,,O City of Orono Date Received: � 1 1't�," i'G C��?l ', <br /> .� u Permit# �`{� �� <br /> `r P.O.Box 66 �� "� <br /> �;;t. 2750 Kelley Parkway �In-House SAC Determination Form Completed ;��' ��\ <br /> a <br /> �j���,�;� Crystal Bay,MN 55323 � <br /> ������.�o� (952)249-4600 Approved By(If Required): <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- Vlav be subiect to further review und mav not be issued when the aoplication is received) <br /> GENER.AL INFORMATION <br /> 1. You may apply for utility pernuts 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 ui�less the pernut 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 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 /> �1ew Connection ❑Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: �� �� / �'� �'', <br /> �� ��r������ %�«- - <br /> Owner:� � Mailing Address: <br /> City: Zip: � <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> , <br /> Contractor: �,�,�J��K� �� Contact Person: UJ ��� C�-�Q��"� <br /> � / � <br /> Address: SQ� ��, e'�-y; �� State License#: ���l�'Ll <br /> City: �jlit 8�v1 �� Zip: �3��xpiration Date: ( �• 3 l- � � <br /> Phone: (�J� ��..� L(�Js:-c�, � �� 17�� ' �� 7�� <br /> / Alternate Phone: <br />