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l , <br /> - FOR CITY USE ONLY � <br /> ��' ��/�I �- City of Orono Date Received: Permit# �Q (Y <br /> � �`, P.O.Box 66 <br /> /l 1 — `i 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> \� ' Crystal[3ay,MN 55323 <br /> .� ��� (952)249-4600/F�(952)249-4616 Approved By(If Required): <br /> ''�i�ii.,c� <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMI'i'S- Mav be subiect to further review and mav not be issued when the a�olication 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 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)for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET A1vD 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 /> �iResidential(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: ����J ����G �,�,,C�� ����L.� <br /> Owner: (.�K, ��"�111+1 T 1(�,�(Y1Q� Mailing Address: DZ�t� l L���� • <br /> City: �1���-� Zip: ��.>� <br /> Home Phone: Alternate Phone: 1�, '�t�'�i�`�i <br /> Contractor Information: <br /> Contractor: �X,�ZX��-� ��'V1:Qt.'��i1X�-�Contact Person: e .�t� /' <br /> Address: �.� ��� � ' �(' State License #: <br /> City: '-Z-�� Zip:� Expiration Date: <br /> Phone: (p�'2= r• •�t�.if� 1�12 -S <br /> �Z :1�L 5 Alternate Phone: � [ <br />