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FOR CITY USE ONLY <br /> -��Z��%�%�'\ City of Orono Date Rcceived: _ Pennit# <br /> �J '� P.O.Qox 66 <br /> �� 2750 Kcllcy Parkway ❑In-1{ouse SAC Determination Form Completed <br /> i , � Crystal Bay,MN 5i323 <br /> � ����, (9�2)249-4600/F�ax(952)249-4616 Approved 13y Qf Required): <br /> CITY OF ORONO— SEWER & WATER/GENERAL PERMIT <br /> (�Nute:Some permits may requirc approval by the Building Of7icial and/or Public Works Dcpartmcnt*) <br /> (ALL NEKMI'I�S- llav be subiect to further review and mav nut bc issued when the application is received) <br /> GENERAL INFORMATION <br /> I. 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 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)far utility stub as-built locations. <br /> DO NOT EXCAVATE IIY 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: � � 0 5 ��e,� n d a L� �� � <br /> Owner:l�h 1� �I" l.l W � � Mailing Address: � 1 �5 �/X�0.CC� /�d VV <br /> c�ty: Lt�a�l z�.�cL z�p: �� 3 4 � <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ���vo,7 �Lumbi/�q ContactPerson: UGVP. O150� <br /> �J <br /> Address: I �v 0� �a'!�Au�/�� State License #: P e, 4 O O� CJ � <br /> City: �S Zip: ��v`���Expiration Date: ��-- 3 ( -- o�C`��� <br /> Phone: ��,�3 — �g 9 --O�5� Alternate Phone: � ��.—3�q-'�'�q d <br />