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� <br /> . <br /> FOR Y �E ONLY <br /> �U/V� Clty of Orono Date Received: � ��ermit# �(!� - �.����):�`' <br /> P.O.Box 66 <br /> �' 2750 Kelley Parkway ❑[n-House SAC Determination Form Completed <br /> , Crystal Bay,MN 55323 �; <br /> ".'�„���� (952)249-4600/Fax(952)249-4616 Approved By([f Required): �� <br /> ',�u,,�- <br /> �= t�C�d �I�NG, `��Z�S 1 <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT ' <br /> (*Note:Some permits may require approvai by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect ro further review and mav not be issued when the aaulicallon 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 handiing 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 1 <br /> � Residential(May Require Approval) ❑Commercial(Approval Required) <br /> �C] 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: \�3�1[,� t=���c ��- <br /> Owner:C,�„�,�,�„y��.r��,.:,� c.��^.�p \ Mailing Address: 1�S��`� �1�.a.:v�bel'�a�y. c�L.. <br /> City: 'G-�e,�, flcu:�r:�. Zip: C��'_�y <br /> Home Phone: ��;l��O�1,�1,•7 6�3 Alternate Phone: <br /> Contractor Information: <br /> Contractor: Co��� r� ��,,.,c� � w�,�el Contact Person: �;�� C,�,�p�_ <br /> Address: �(��-1 Qti;a,�,�,,c�, State License#: s 73 �.�1 - fti'{3 <br /> City: C,,/'u��E-1c,c,.,r� Zip:S.�j' _4�� Expiration Date: \�. � 3�- ��� <br /> Phone: �`��- - 5,c� �N�17`-� Alternate Phone: <br />