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,h <br /> A <br /> FOR CITY USE ONLY <br /> �r(� City of Orono Date Received: Permit# <br /> �¢ �� P.O.Box 66 <br /> �/O , 4�` <br /> + �,;,,.,,, 2750 Kelley Parkway ❑In-House SAC Determmation Form Completed <br /> �� �� �r,-;. �) Crystal Bay,MN 55323 <br /> �,'�,�� r�n�,�,b�`/ (952)249-4600 Approved By(If Required): <br /> \�Oy�"' <br /> CITY OF ORONO – SEWER & WATER/GENERAL PERMIT <br /> (*Note:Some pennits may require approval by the IIuilding Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoplication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the Ciry 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 IN ANY STREET AND DO NOT TAP ANY MAIN without express <br /> approval of the Public Works Department. lssuance 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 /> Job Site/Owner Information: <br /> Site Address: ��/�"� �1l .�� <br /> Owner:,����L ,,�y��/�/'��5� Mailing Address: ���r� <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> n <br /> Contractor: 1�'�/� s Contact Person: ,�� <br /> Address: � o � State License #: �.� <br /> City: Zip:� Expiration Date: /� ��i—c �� <br /> Phone: ��v 7 v� � Alternate Phone: �o/Z .S/�-0 7�`7 <br />