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. _ <br /> - �ox crrY u��oiv�.v �/ <br /> ����0� City of Orono Date Received: Per�►it� ���L— ���v <br /> ! � P.O.Box 66 <br /> � ' ; 2750 Kelley Parkway ❑In-Ho�se SAC Determinarion Form Completed <br /> i iF � <br /> .�-f Crystal Bay,MN 55323 <br /> \\�is`io j f (952)249-4600/Fax(952)249-4616 Approved By(I�'Requiredj: <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Departrnent') <br /> (ALL PERMITS- Mxv be subicct to furt6er review and mav not be issued w6en the aoolicadon is receivedl <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 handling fee shown below. Permit cards will <br /> be sent by retum mail within 2 business days. <br /> 3. Permits are not valid uutil you receive a permit c$rd. <br /> 4. Work must not begin unless the pemut cazd is available on the job site. <br /> 5. Urility connecrion permits may be issued to licensed contractors only. <br /> 6. Contact tbe Public Works Deparfinent(952-249-4600)for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without ezpress <br /> approval of the Public Works Department. Issuance of a pemut does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 8. All work m�st be inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> TYP�OF PER1vIIT <br /> Check All That A i <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection �Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> [] Water Availability Connecrion For Future Hook-Up to Water <br /> Job Site/Owner In#�ormation: <br /> SiteAddress: �S 65 � � ��ir�r�W ��}�� �n <br /> Owner: �I �"��}h,y 1��eC 1�e� Mailing Address: �S �S �ol�rli i�b✓ Cu}�G.yl �� <br /> ��Ty: C� r� ��� Z�P: _S�s 3 �� <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> ��1�► �-s���5 �'�iu►r ��Ili� <br /> Contractor: � F Contact Person: <br /> Address: ����'�� C� �� � State License#: <br /> �.�,` J�') <br /> City: l�v����`� Zip:`S S Expiration Date: <br /> Phone: -1-�a�� L�� � ���J Alternate Phone: <br />