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♦ � <br /> FOR CITY L'SE ONLY �} ��9� <br /> ,��,�` City of Orono Date Received: Permit# (/�� <br /> "r P.O.Box 66 <br /> �', � 2750 Kelley Parkway ❑ln-House SAC Determination Form Completed <br /> �,,;� <br /> � � 1`' Crystal Bay,MN 5�323 <br /> �,� ��'� o� (952)249-4600 Approved By(If Required): <br /> ���� <br /> ��o <br /> CITY OF ORONO —SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public W"orks Department*) <br /> (ALL PERMITS- Mav be 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 perniit 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 accardance 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 Apply) <br /> �esidential(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: � � �S � �c;(s-�z SS ��. \�'� <br /> Owner: Mailing Address: <br /> City: �J��G Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor:��c,.c�.� �_��e� (��u„c��Contact Person: ���-� <br /> Vec.�,;�� S-�, <br /> Address: � �'�-U ( �c�n,�.� State License #: <br /> City: ��C�-��c� Zip:�S3'�,`Y�j Expiration Date: <br /> Phone: �v �,),- �(c(- (�f I� 1 Alternate Phone: <br />