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FOR CITY USE ONLY <br /> 0,��,�`O CitV of Orono Date Received: Permit# <br /> `r P.O.Box 66 <br /> �F,��ti,,, 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> .� Ij ?, �; � Crystal Bay,MN 55323 <br /> ���g�-yo (952)249-4600 Approved By(If Required): <br /> e <br /> CITY OF ORONO -SEWER & WATER/ GENERAL PERMIT <br /> (*Note:Some permits may rcquire approval by the Building Official and/or Public R%orks Department*) <br /> (ALL PERMITS- Ma�•be subicct to further revien�and mav not be issued when the application is reccived) <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 mai] within 2 business days. <br /> 3. Permits are not valid until vou receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Utility connection pernuts 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 pernut 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 Apply) <br /> ❑ Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> �New Connection ❑Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site /Owner Information: <br /> Site Address: �► � � �' �-�l� ���'�C �/�S `� <br /> Owner: `��� �a���; Mailing Address: `f.�S,S- /�6.�4-✓E v �'c1�- <br /> City: � Zip: .S�/ <br /> UE:�-� <br /> Home Phone: � Alternate Phone: �,S`Z - z� � `- ✓�Y�j <br /> Contractor Information: <br /> ;%� /� <br /> Contractor: --� � ��J �� o�ct Person: ��� �%�/���� <br /> ,��/J�. ��'' <br /> -�,�,=��/�%� �'p `�` <br /> Address: ��� �� State License #: ����� -�4'j�/ <br /> City: ip: Expiration Date: �-���� <br /> `�_,./ .T--- � <br /> Phone: �-�J�-�/��� Alternate Phone: /o` C% �Y� ��! <br />