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•• FOR CITY USE ONLY <br /> � ���^/� City of Orono Date Received: Permit# <br /> P.O.E3ox 66 <br /> 1 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> . Crystal Qay,MN 55323 <br /> ��.`����4��� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> CITY OF ORONO—SEWER & WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Oflicial and/or Public Works Department#) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoolication is receivedl <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 AI�IY 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: ��y(� �r,7c �� <br /> Owner:C ►,,�r�,.;Y. �.�,�c,,� Mailing Address: 1\S"7Y� C�.�;,mhQr��,:,. c;� <br /> City: E�er� F'r-�.:r_ Zip: S�-�`-1� <br /> Home Phone: `�5�.`�,y°1-7 6�`T, Alternate Phone: <br /> Contractor Information: <br /> Contractor: C_o���,r,;e,.� L ,,,;;��� Contact Person: (�:�� ��, ,;.,� <br /> Address: ��� Qu�_',��j State License#: S� 3�.q �M�2 <br /> City: i,�J�L,,�, .,,, Zip: .+��_ Expiration Date: 1 a.�3\-�(;, <br /> . <br /> Phone: �\�-���- �y�y Alternate Phone: <br />