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./ � <br /> _ I U��S ONLi' <br /> � ���NO� City of Orono Date Received: Permit# 0�01 Cp— lQ�d <br /> � `•; P.O.Box 66 <br /> ! 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �,y�' �-;' Cryscal Bay,MN 55323 <br /> \\�is'i o j f (952)249-4600/F�(952)249-4616 Approved By(II'Rtquiredj: <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some pem�its may requ'ue approval by the Building Official andlor Public Works Departrnent*) <br /> (ALL PERMTfS- Mav be subiect to furt6er review aod mav not be issued when the aoolication is receivcdl <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 aze 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 permit card is available on the job site. <br /> 5. Urility 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 ezpress <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 i <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/Ovvner in�o�ation: <br /> Site Address: �f C� t� �4� �.� <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Altemate Phone: <br /> Contractor Inforrnation: <br /> Contractor: 11UC_"���0l�1 �� ��w Contact Person: , �'� q�'�T <br /> Address: ��0 r �O� /��'` � � State License#: <br /> City: " ✓!� Zip:�SJ�/ Expiration Date: <br /> Phone: ��� ' y7-�- ��7 Alternate Phone: .��- ���" ' �j <br /> / <br /> ��� (� �n �� l.-�� S ��i! � <br /> � <br /> l � � � <br />