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� <br /> EO�2 C�T1(USE ONLY ;, � -� <br /> ,��� City of Orono Date Received: .7� Yem�it# ��i /��( <br /> P.O.Box 66 <br /> ��;, � 2750 Kelley Parkway ❑In-1-Iouse SAC Deterniination Fonn Completed <br /> a� ��j��,<<L_ � Crystal 13ay,MN 55323 <br /> �t��(.�}��;,�$u` (952)249-4600 Approved By(If Required): _ <br /> 4xseNo <br /> CITY OF ORONO -SEWER & WATER/ GENERAL PERMIT <br /> (*Vote:Some permits may require approval by the Building Ofticial and/or Public Works Department*) <br /> (AI I PFRMITS- Nlav he subi�ct to further review and mav not be issued when the nnnlication is received) <br /> GENERAL 1NFORMATION <br /> 1. You may apply for utility pennits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut 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 pern�it card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed conri-actors only. <br /> 6. Contact the Public Works Department(952-?49-4600)for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MA1N without express <br /> approval of the Public Works Department. Issuance of a pernut 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 Apply) <br /> �Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑ New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ,�Disconnect <br /> Job Site/ Owner Information: <br /> , <br /> Site Address: ��F�� `'� +� L�n 1 �� � V • <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> 1ti/ ��l Y` S /� <br /> Contractor: `�� ' �' � Contact Person: ���y�� ����'�'` <br /> �� <br /> Address: ���� ���. ��� 1�� State License#: ] �c]� I��`� <br /> City: � c.k� Zip:'553��'�Expiration Date: � ������-�� <br /> Phone: � ��o�i\ ����-���� Alternate Phone: �j �� ?�l -� 7.� / <br />