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, . <br /> . <br /> FOR C1TY USE ONL,Y <br /> .�� �y j'`� <br /> ���C'—''- �r-� Clt3'of Orono Date Received: Pemut# <br /> ���\ P.O.Box 66 <br /> !, ��, � 2750 ICelley Parkway ❑In-House SAC Determination Form Completed <br /> ;.-`�� ' .�1 Crystal Bay,MN 55323 <br /> ��� ' '�'1. -f� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> 't.�;,��,�. <br /> CITY OF ORONO- SEWER& WATER/ GENERAL PERMIT <br /> (*!\ote:Some permiu may require approval by the Building Official andlor Public Works Department*) <br /> (ALL PERMITS- Ma� be subiect to further review and mac not be issued when the application 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 MAIl\`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 /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 3��� �7�9L��y �¢� <br /> Owner: �ilil „�LrTZ- Mailing Address: <br /> city: O�D�s/D zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ,�S , t��iS��N,b��vGContact Person: /l/i�c'� ��/���✓� <br /> � <br /> Address: Z"/� �i1fi�'-�'�/S+�f� , State License#: <br /> City: �Nbs Zip:�� Expiration Date: <br /> Phone: �m5/- �g0 •/35�� Alternate Phone: lG/Z �/9�`��y� <br />