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/G5.l� <br /> --— , TY USE ONLY�,, , / / <br /> j:',5��-�-1�� Cit��of Orono DateRece Permic# �1�� <br /> ;r � P.O.Box 66 <br /> ; � 2750 Kelley Parkway ❑In-House SA D ermination Form Completed <br /> t'_�4 � , ��� Crystal Bay,MN 55323 <br /> `�'���'��"'� �� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> �:.?.:,�;�'� <br /> CITY OF ORONO— SEWER & WATER/GENERAL PERMIT <br /> (*hote:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Ma�•be subiect to further revieN and ma�not be issued when the aaaGcation is received) <br /> GENERAL 1NFORMATION <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��alid unril 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 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 /> ,_!,�,,( <br /> I/;I Residential(May Require Approval) ❑Commercial(Approval Required) <br /> � <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: ���/ �'�y��'��� �� <br /> Owner: L� ,�L�-�S� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ���/�� �,�'-�i`�T'✓b ��• Contact Person: ///,/� C��,+Zin/� <br /> , <br /> Address: r�9�(o ����ki/�l7l'��State License#: <br /> City: �""✓� Zip:S�J Expiration Date: <br /> Phone: ���"y�d``��J Alternate Phone: �/� �i9 �3�1v� <br />