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FOR CITY USE ONLY <br /> �.�/�/0 City of Orono Date Rcccivcd: Pennit# <br /> P.O.Box 6G <br /> 1 ' 2750 Kcllcy Parkway ❑In-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> � `., ✓�� ��` (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> hisn���- <br /> CITY OF ORONO- SEWER & WATER/GENERAL PERMIT <br /> (*Note:Somc pennits may rcquirc approcal by thc Building Ofticial and/or Public Works Department*) <br /> (ALL PERMIT5- :Vlav be subiect to further review and mav not be issued when the aaplication 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 below. Pernlit cards will <br /> be sent by reriirn 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 pennit 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 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 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: ��� Z l �w1k��ll�=L,�i._� �_r�l�-��- <br /> Owner: iC°�-} -��,� ���C,�.� <� Mailing Address: z�%i�ll �4-)�Z yl�:r.'� �.�'���'C: <br /> City: U,�t�lU(� Zip: `5,5�5� <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractar: �(,i..iL"ltt,� ��'�1�tV��,$"�i��Contact Person: ���"�����L-; /�,�%�/�_�U y <br /> Address: �� 1�v L�L��li�i�y I�vi-�.I �f State License #: ���.� 1�=LV.��r L:;",'c� <br /> City: jV����L Zip;�����_�' ��� Expiration Date: <br /> �}E������-�i�-- Phone: �G'lC.� � �{'� "L/_�U.�� �, Phone: (%SZ� �'��5�- �ll Z. <br />