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k ' � <br /> e <br /> FOR CITY USE OtiLY <br /> ,��`., City of Orono Date Received: Pennit# � ����� <br /> iO�O`�`O`�� P.O.Box66 � <br /> *. <br /> ti 2750 Kelley Parkway /�In-House SAC Detcrmination Form Completed �� � <br /> � n���- � �,�� Crystal Bay,MN>5323 f���� ��'a <br /> ��d s'� �'r�.i$G`�i (9�2)249-4600 ApprovedE3y(IfKequired): <br /> . t_���pA.:; <br /> ^�/t <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits mav requirc approval by the Building OYficial and/or Public Works Department*) <br /> (AL1,PERJIITS- 1�tA�°bc subiect to further review and mav not be issued when the application 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 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 EaCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express <br /> approval of the Public Works Department. Issuance of a pennit 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 ootice required. <br /> TYPE OF PERMIT <br /> (Check All That A I ) <br /> �Residential (May Require Approval) � Commercial (Approval Required) <br /> � New Connection ❑ Additional Connection � Re-Connection � Repairs � Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: !��S �� [ v�r�5��� � f- <br /> Owner: C.f�v''�Aiut (�✓iStR�chu.����""`��ilingAddress: ��i��v�S fi /lwn:;e S r <br /> City: ��lx'i���'v e✓' Zip. �,� <br /> Home Phone: ��� 3���,,:��9S Alternate Phone: <br /> Contractor Inforination: <br /> Contractor: �,'R��u �=z�dN�►+��� !�+� Contact Person: � ��'�y �.'R�l �� <br /> Address: � �1 `3 � ��A�t�e�',r�t ���- State License #: c�,71 N <br /> City: (�fC�� Zip:..�s.ju3 Expiration Date: yIQ� <br /> Phone: s,�.o-c�1��' i��S��' Alternate Phone: 7 e j � v���' �I 7 I <br />