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. —� <br /> w . .� <br /> /p,�07 <br /> F R C��J,SE ONLY �a�J <br /> 0 City of Orono Date Received�/ ��S"rmit# .��/� / <br /> O¢ �O P.O.Box 66 <br /> �,',wa 2750 Kelley Parkway ❑ In-House SAC Determination Form Completed <br /> a ����?�l;r� p Crystal Bay,MN 55323 <br /> ��'.� � 4�'�.b�� (952)249-4600 Approved By(]f Required): <br /> �����ti <br /> �EBA�B <br /> CITY OF ORONO —SEWER & WATER/ GENERAL PERMIT <br /> (*Notc:Some permits may require approval by the Building Official andior Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the auplication is received) <br /> GENERAL INFORMATION <br /> L 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 pernut 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 Al\TY 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 wark 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 [�'�e-Connection ❑ Repairs ❑ Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/ Owner Information: <br /> Site Address: J�-�� C('V� S�GI.-Q �L. <br /> Owner: [ Y I�� ��'1l.(�t(�L.S(.�� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ��1��'..�'�>-Q I� �0- Contact Person: �C � � C,�-�4' 1' <br /> Address: �-� ��� �� 1J1�° State License #: <br /> � City: �E-�� Zip:_��'l�� Expiration Date: <br /> Phone: ({'I 2��,�- . ��f L�� Alternate Phone: ���j� �(���. �(CU� <br />