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r . � <br /> FOR CITY USE ONLY <br /> �4(��\.\ City of Orono Date Received: Permit# <br /> `` P.O.Box 66 <br /> ��;�;, ��� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �� }���r�� �+ Crystal Bay,MN 55323 <br /> ��+h��`�4;yG�`� (9�2)249-4600 Approved By(If Required): <br /> `� <br /> \�-�=- <br /> CITY OF ORONO—SEWER & WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department"') <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the anplication 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 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 ] )��� <br /> ��esidential (May Require Approval) � Commercial(Approval Required) <br /> ! \ <br /> � New Connection �, Additional Connection �Re-Connection � Repairs�Disconnect <br /> Job Site/ Owner Information: <br /> � <br /> Site Address: ✓ , � � s � C�i� <br /> .7 o y <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> _ ��,��/'�" �c?.✓l.v��� .�.r�"�� / <br /> Contractor: �Q Contact Person: (,��I,�C �,�� ��/� <br /> Address: � ��� ��� �ate License #: <br /> � . - <br /> City: � :�(G�`��Zip�3��xpiration Date: �L � `� � <br /> Phone: 7F�� ^��Z�'"��'�,� Alternate Phone: �Y�,�� �� — �� �—���� <br /> ��� ��� � <br />