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� l �• <br /> -"'��-. <br /> F CIT IJ�E ONLY^ _ . �/]/ <br /> �'-.��i��!Er;,-�-, CitV of Orono Date Received� Permic#v�0� `f� <br /> ` ' P.O.i3ox 66 <br /> 1 1 <br /> � � 2750 Kelley Parkway ❑In-House SAC D e ination Form Completed <br /> �\� � � Crystal Bay,MN 5�323 <br /> r', �'� (952)249-4600/Fvc(952)249-4616 Approved By(If Requ red): <br /> „n�'= <br /> CITY OF ORONO— SEWER & WATER/ GENERAL PERMIT <br /> (*Note:So�ne pennits may require approva]by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued w�hen thc application is received) <br /> GENE L INFORMATION <br /> I. ou may apply for utility permits by mail or in person at the City offices. <br /> 2. ailed 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 un61 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. lssuance 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 /> C T'YPE OF PERMIT <br /> (Check All That Apply) <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 Adidress: //�f /h4iDD� .,,1 • <br /> Owner:�L�OLFiQ,I' ,BGD�. Mailing Address: <br /> City: ,, Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contrad,tor: ,oS,/I�. �Uql�'lT�NL /N�. ContactPerson: /��,�� �oD�,�-�yL <br /> Addres�: 29/��S'� �� State License#: <br /> City: �� ��N�.S Zip: ��33 Expiration Date: <br /> Phone: �.�/ �SD-/��� Alternate Phone: <br />