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� <br /> FOR CITY USE ONLY <br /> �,�` City of Orono Date Received: Permit# <br /> O4 `rO P.O.[3ox 66 <br /> i �;.„, 2750 Kelley Parkway ❑ In-House SAC Determination Form Completed <br /> a ��`6?�' Crystal Bay,MN 55323 <br /> �A����.�o� (952)249-4600 Approved By(If Required): <br /> o$ <br /> CITY OF ORONO- SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PER:VIITS- Mav be subiect to further review and mav not be issued when the apn��cation is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for urility permits by mail or in person at the City offices. <br /> 2. Mailed in applicarions 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 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 Apply) <br /> ❑ Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs isconnect <br /> Job Site/ Owner Information: <br /> Site Address: � � � � '`�^ ��� ' �� `� � <br /> � �` Y <br /> Owner: 1 <br /> ���' \' \Cl� 1�` �-i +� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: � Q Q•j (� S'�'`-' Contact Person: `-�a Yl C:..� <br /> Address: � l b� C�-7 Q� ( S State License#: � � 7 � � <br /> City: �u � 0.' Zip:��3S`) Expiration Date: �� �3 � " O � <br /> Phone: �S o� `�7 .�- ' � �i 7 � Alternate Phone: �o � � o� T d (� �.,,2 � <br />