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� <br /> ���SE ONLY � <br /> �� Clty of Orono Date Receive Permit#�3� <br /> �'"/�O�� P.O.Box 66 <br /> ��/� �`? �750 Kelle Parkwa In-House SAC Determination Form Completed <br /> �` �' � Y Y ❑ <br /> � �7'� ? ' �' Crystal Bay,MN 5�323 <br /> �\�� '�i��.���i�� (952)249-4600 ApprovedBy(If Required): <br /> \� p6t'. <br /> ��� <br /> CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some perrrtits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not bc issued when the aoplication 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 be]ow. 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 Al�'Y MAIN without express <br /> approval of the Pubiic 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 A 1 <br /> �,Residential (May Require Approva]) � Commercia] (Approval Required) <br /> ❑New Connection ❑Additional Connection ❑Re-Connection �Repairs � Disconnect <br /> / ` <br /> Job Site/Owner Information: <br /> ' ? -- <br /> Site Address: ��L'� �'"� (�� � �i"� <br /> I°Y) t/U, <br /> Owner: �k:U� �v�1�L(, Mailing Address: <br /> City: (�r�.�p Zip: <br /> Home Phone: � � ��J��J— �?`� Alternate Phone: <br /> Contractor Information: <br /> Contractor: �� :�- U Contact Person: /,�/��'K �C""' <br /> Address: ���� , `l� ��(�(J, State License #: ��S`�� — r rY) <br /> City: � Zip:.��� Expiration Date: �a����(��"J <br /> Phone: 7�1�-.5I`� - �1t�� Alternate Phone: �� �c).�'J/ <br /> ,�, <br /> ,!I''' <br /> � �� �j '�'I: <br />