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� � � <br /> - <br /> FOR TY 'SEONLY ��!/�) <br /> �-�_---�, <br /> ;r;�-'�0�-�7���, City of Orono �ate R e� Permit# o T�'' <br /> 1 � '� P.O.Box 66 <br /> ,� 1 g 2750 Kelley Parkway ❑ln-House SAC Determination Foim Completed <br /> ' �ti ' ;� .-/ Crystal Bay,MN 55323 <br /> �• � ��`��'� 1 (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> � n�,�,.�'-_ <br /> CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT <br /> (*Note:So�ne permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PER�IITS- Mac be subiect to furthcr review and mav not be issued when the applicallon is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the Ciry offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will <br /> be sent by return mai] within 2 business days. <br /> 3. Permits are not valid unril 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 A1VY STREET AND DO NOT TAP ANY 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 C,ode 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 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� rl�i�' 1/i�-"uJ (�.o /l '�`�`� Lt�� <br /> Owner: Mailing Address: S�"'�E <br /> City: ����v f Zip: —�✓���� <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ��/�v�.s �}l� ��=- Contact Person: �'C/�' <br /> Address: �G��' �� ����s� State License#: � "`'�-� � � <br /> City: �� /?. �i' C�y/Zip:�i��Expiration Date: '7' -��' l� <br /> Phone: 1�� `���a���� Alternate Phone: �e`l���-�v� -�T-� -�� 7� <br />