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. 1 <br /> �'`^� FOit CTI'Y USE ONLY <br /> ��-����, City of Orono Date Received: permit# <br /> ', P.O.Box 66 <br /> j � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> \�\��' ,�-f Crystai Bay,MN 55323 <br /> "`1_. 4,��� (952)249-4600/F�(952)249-4616 Approved By(I�'Required}: <br /> �!�cs�i,�� <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERNIIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Departrnent') <br /> (ALL PERMITS- Mav be subiect to turther review and mav not be issued when the ao�lication is receivedl <br /> GENERAL INFORIv�ATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applicarions aze 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 cazd 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 ANI'MAIN without express <br /> approval of the Pubiic 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+6our notice required. <br /> TYPE OF PERMIT <br /> (Check All That A i <br /> ❑Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connecrion For Future Hook-Up to Water <br /> Job Site/Owner inforrnation: <br /> � �1 �� � <br /> Site Address: � �- � --� ��S <br /> Owner: ���M g Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: � <br /> Contractor:� 0� �w Contact Person: `�� � <br /> Address: ��� � W�—�- � State License #: <br /> City: /'�Z�� Zip:��xpiration Date: <br /> Phone: �o / � �� ,7 ��—��Alternate Phone: <br />