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r • <br /> FO CIT iJSE ONL]' <br /> �- �(�"` City of Orono Date Received:..�/ � Permit# fo1D S <br /> „O�¢' '�'p�l P o.8��;�� <br /> ,;... . � 2750 Kelley Parkway ❑ln-House SAC Determination Form Completed <br /> �il� tj�R � ��� Crystal Bay,MN�5323 <br /> �d 'i� r GJ (952)249-4600 Approved By(Ifi Required): <br /> ;� �» <br /> assco�`" <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval bl'the Building Official and/or Public Works Department*) <br /> (_ALL PF,RMITS- �1av be subiecf to further review�nd mav not be icsued when thr apn��cation 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 wili <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 EaCAVATE IN ANY STREET AND DO NOT TAP ANl' 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 1 ) <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� ��y� �j iy���/ � � <br /> Owner: i�_ �,� � Mailing Address: <br /> City: D ,�v- zip: <br /> Home Phone: Alternate Phone: G�/�-,3(0_ '-�/yc,� <br /> Contractor Information: <br /> Contractor: ������ � Contact Person: � � �� <br /> Address: ,����G��� S � State License #: Zoo-S= /8S'� <br /> City: r�' - Zip:�� Expiratio�� Date: <br /> Phone: �G3-Z1-3� yl�l/ Alternate Phone: <br />