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. <br /> FOR C�ITY SE ONLY�, <br /> ���0 City of Orono Date Received: - �ermit# 'j ('��(„ -./';/- �i� <br /> P.O.Box 66 �p��� <br /> �1 2750 Keiley Parkway ❑In-}Iouse SAC Determination Form Completed <br /> , � Crystal Bay,MN 55323 � �.��(0 <br /> ',`!��. �� (952)249-4600/Fax(952)249-4616 Approved By(If Required): S�I C { f v ^ �, <br /> ��v.��.,ti <br /> ����.� � <br /> CiTY OF ORONO—SEWER & WATER/GENERAL PERMIT � �j`��'' <br /> (*Note:Some pertnits may require approval by the Building Official and/or Public Works Depar[ment*) � <br /> (ALI.PERMITS- Mav be subiect to further review and mav not be issued when the aaDlication 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. Pernut 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+bour 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: ��� � �-On�o f��o.. 5!- <br /> Owner: (�jL.���ta K�a'.S�.( Mailing Address: ����, Qsuv', aonr a..Q1. <br /> City: 3,�a�p�z Q,.� ,� Zip: S S 3 S� <br /> Home Phone: ��a-�3(�� �S�\°� Alternate Phone: <br /> Contractor Information: <br /> Contractor: C=c�4�_�o..u' i, �;:t�.e� Contact Person: �.\\ c�,a�;� <br /> Address: $�-1 c2s.1v.�� nl(.�rl State License#: S�3 0�l`�',�►�Y�. <br /> City: �,y;���.� Zip:S�� Expiration Date: '��.� 3\- �� <br /> Phone: ro�a--S0��q��� Alternate Phone: <br />