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� , • ," <br /> F CI USE ONLY / <br /> ,-�����f-� City of Orono Date Reccived: Pertnit#o?l�t 5-L� �! <br /> P.O.Box 66 <br /> , 'Y�� ' 2750 Kelley Parkway ❑In-Itouse SAC Determination Form Completed <br /> �� � , Crystal Bay,MN 55323 <br /> � .��,t� � (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> =-�'ftt�t. <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 PF,RMTTS- Mav be subiect to further review and mav not be issued when t6e aoalication 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. Permit cards will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are not valid untit 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 Deparnnent(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 /> SiteAddress: � !.S ����5�� ��� S l��J <br /> Owner: Mailing Address: <br /> City: �/�U/l/ G� �'j1� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ��!�C kS �X � Contact Person: ✓� <br /> Address: ��D W �jL'7�5� State License #: ,� ' ���p <br /> City: �hC�.v�/1 �SS �'�`1 Zip:3��f�xpiration Date: ��'�� °- ���� <br /> Phone: �-�� ���-�7�� Alternate Phone: ��� ��t�2 ���� <br /> �el�- °1-�� � l z � 2S �� <br />