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, �._ <br /> � <br /> FOR CITY USE ONLY <br /> 4 0,�` Clty of Orono Date Received: Permit# <br /> "r P.O.Box 66 <br /> �' � 2750 Kelley Parkway <br /> �' �wa ❑ In-House 5AC Determination Form Completed <br /> a ����A;�_ Crysta]Bay,MN 55323 <br /> �d����u�f;��-�.�o� (952)249-4600 Approved By(If Required): <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 application is received) <br /> GENERAL INFORMATION <br /> L You may apply for utility pemuts 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 pernvt card is available on the job site. <br /> 5. Utility connecrion permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Deparrinent(952-249-4600)for urility 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 pernut 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 /> Site Address: I �� s (' �� ��.� '�� �.1 <br /> Owner:�fCJ Tr��^' ' �' Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: �p � � �Z S S�IS C <br /> Contractor Information: <br /> Contractor: �%��"��r��'1 �"�"'"�� Contact Person: � <br /> Address: /' � �"x Z`17 State License #: /`7� �� �� � <br /> City: �°'�� Zip:SS 3S� Expiration Date: � � � <br /> Phone: ��Z �S�� � ��� Alternate Phone: ��L �s / - ��'t�`� <br />