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� <br /> FOR CITY USE ONLY <br /> O,¢��O City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> . 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> a i,a'f• �. Crystal Bay,MN 55323 <br /> ':��+ � .0�/1� (952)249-4600 Approved By(If Required): <br /> <Vr�xo�,i�! <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Deparlment*) <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 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)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 ply) <br /> � Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> �,New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> Job Site/Owner Information: <br /> Site Address: yy��?' ��,Q1t�i" .�/�Kl� �/�/Ul�l/U(� <br /> Owner: �,�r� ���/L�O�i.� Mailing Address: ��P���D �%t X�S �J���/�_ <br /> City: ��ID,Q, �/�1�� Zip: .1�. -J'���' <br /> Home Phone: `� Alternate Phone: �/�- ���-�3/� � <br /> Contractor Information: <br /> Contractor: �illy�f��-.��A,I�� �L`'�• Contact Person: ��Il/'N«� /�/�l.l�l�L/f�/l�S <br /> Address: �31 S ,��,Qf}5 >r�1t�l State License #: /y�r-�- <br /> City: .S 1�K0��'� Zip: �A� Expiration Date: <br /> Phone: `�, �a�3'/p�0�� Alternate Phone: �/��?lr�/'i�t��� <br /> s�4 C C�ra r�c-�a��-�c�. �n <br /> ����3�7 Z.. <br />