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r � <br /> FOR CITY L SE OtiLY <br /> City of Orono Date Received: Permit# <br /> r�����,' P.O.Box 66 <br /> � � ' 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> J <br /> a si� * �' Crystal F3ay,MN 55323 <br /> �t� '�,. t o`,:� (952)249-4600 Approved[3y(If Required): <br /> >:i�awxos`-' <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by thc Building OfYicial and/or Public Works Department*) <br /> (AI.I.PERMITS- J1av be subicct to further review and mav not be issued when the anolication 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 AIYY h1A1N withoat 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 �vork 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 /> � <br /> �esidential (May Require Approval) �Commercial (Approval Required) <br /> ❑ New Connection ❑Additional Connection �Re-Connection ❑ Repairs ❑ Disconnect <br /> ❑ Water Availability Con ction For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: ���S ����/�'��l�-'-' ����� % <br /> Owner: �2�/�`N (��� ,btJ � Mailing Address: <br /> City: ��-CS-,:��= �� � Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> � �� <br /> Contractor: �1 �v--� �i.;� L�'y6 -,�/��n act Person: � ---�i����� <br /> Address: � � ` - � �- , <br /> ,�c��x��� State License#: �����G <br /> � <br /> City: ���i^i �S Zip:_�,��cpiration Date: ������ <br /> � �� <br /> Phone: Alternate Phone: — -; � <br />