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! `r <br /> - FOR ITY.U5 ONLY <br /> i g-O/�I City of Orono Date Received: Z( _ Permit# �-0�{�(`, �3 � <br /> �\` P.o.aoX 66 � 1y <br /> j � ! 2750 Kelley Parkway ❑ImHouse SAC Determination Form Completed � <br /> `, � � t,,- Crystal Bay,MN 55323 <br /> �. .�:� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> �����ECHOSiF � <br /> CITY OF ORONO-SEWER & WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aaalication is receivedl <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 handiing 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 EXCAVATE IN ANY STREET AND DO NOT TAP A1�IY 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+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 ❑ Re-Connection ❑ Repairs �Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> � <br /> Site Address: � � 5 � C�'�U- � — t� <br /> `�'�Q/y�J� Czh�c. <br /> Owner: � v -�1�� �c�S � Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> , <br /> �-� ,� � �' � _--- . <br /> Contractor: � �-�'� � C��L����ontact Person: � ��--�� � �-w'�-�? <br /> ���1, � � � S <br /> Address: S ��J ��w"'�7` �""'"�tate License #: � � � � � � � <br /> ,-�.s-�"1 <br /> City: ��` ��'��''-�� ��Zip:S `5 Expiration Date: <br /> Phone: �� Z` ��� �s�3 5 S Alternate Phone: <br />