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FOR C1TY USE ONLY <br /> ^ ,1� City of Orono Date Received: Pemut ti <br /> � ¢O`�` P.O_Boxb6 _ <br /> �' � '`�r ��. 4 1 2750 Kelley Parkway ~ ❑In-House SAC Determination Form Completed <br /> , :��,' '- r Grystul BAY.MN S>323 <br /> ' �'_ �.:_'-' � �' ' A oved By t Re uired): <br /> 1 � -. G� (y52)249-46(x� PPI (�' 4 <br /> � . . ,�t,es�o� <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> ("Note:Some pennits may require approval by the Building Official and/or Public Works Department•) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aonlication 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 wili <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 AND 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 PERNIIT <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: ? � � � 17��'(f� �t��_�� l/' --� <br /> Owner:�'rl�°LC�u e �CS�j���/' Mailing Address: <br /> ,- <br /> c�ry: �v �n U Z�p: S s3 y l <br /> Home Phone: � �� � C � � �f(-3 SAlternate Phone: (��l�- ��S -y S 3 � <br /> Contractor Information: <br /> , <br /> Contractor: � � �����`� ��Un;�/� 5 Contact Person: � �� �����5�� 1�7 <br /> Address: �_�r/r��I1�IP.�.��''14� � State License#: �I�� �J�j�� <br /> City: <br /> �/n�1�����t Zip����Expiration Date: �3� ��U �' <br /> Phone: (./��� � `1� �`1 y� Alternate Phone: �� ��-�� ��� v <br />