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, <br /> FOR CITY USE ONLY <br /> Clty Of Orono Date Received: Permit# <br /> 040�0\ P.O.Box 66 <br /> 2750 Kelley Parkway ���fa'u� ❑In-House SAC Determination Form Completed <br /> ���.� p`�'�• �� Crystal Bay,MN 55323 <br /> ';��_'�_+��i;�ya�' (952)249-4600 Approved By(If Required): <br /> `�'ssxo�%� <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- Mav be subiect to turther review and mav not be issued when the aoolication is receivedl <br /> GENERAL INFORMATION <br /> ]. 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 until you receive a permit card. <br /> 4. Work must not begin un(ess 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 [N ANY STREET AND DO NOT TAP ANY MAIN without express <br /> approval of the Public Works Department. [ssuance 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: � � � S ����t�� �a �� ��'�� <br /> Owner: y/ tie�� ����� Mailing Address: <br /> City: ����ls'F��� Zip: ��`�� <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> �, , <br /> Contractor: ��P S /'c��/'S Contact Person: i'/'i✓� ��P� <br /> �x�r��� �n T�tC - � <br /> Address: �f//y � J uc�.�c� State License#: �� �'' �53 5 <br /> City: �/��.J !'I�i+i'��'� Zip: �sb Expiration Date: �� ` 3�` l� <br /> �� <br /> Phone: �P/a '�(o(Q~`7�q�S Alternate Phone: <br />