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w R <br /> � <br /> ( <br /> - �" FOR CITY L?SE ONLY <br /> '1�Z��y�j City of Orono Date Receiced: __ Permit# __ <br /> P.O.Box 66 <br /> , ' 2750 Kelley Park�vay ❑In-House SAC Deternunation Form Completed <br /> � i , - Crystal Bay,MN 55323 <br /> �� (952)249-4600 Approved By(If Required): _ <br /> CITY OF ORONO- SEWER & WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Buildine OY�icial and�'or Public Works Department*) <br /> (ALL PERnIITS- blav be subiect to further revie�•and mav not be issued w•hen the aaolication 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 /> �. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the pernut card is available on the job site. <br /> 5. Utility connection pennits may be issued to licensed contractors only. <br /> 6. ConCact the Public Works Department(952-249-4600)for utiliry stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express <br /> ap�roval of the Public Works Department. Issuance of a permit does not grant this approval. <br /> 7. All wark must be done in accordance with State Code reyuirements. <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 Connecrion ❑Re-Connection ❑Repairs ❑ Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site /Owner Information: <br /> S ite Address: y�5 l0 ��Q�(1 �N[�C�G� �-G,. <br /> Owner: cSGo� ,f�1�.��S�e.�� Mailing Address: �l�(p �(�,��1 <br /> c�ry: G�or�� z�p: 5S 32 3 <br /> Home Phone: �"1 S Z" �1��' �y 7'3 Alternate Phone: <br /> Contractor Information: <br /> Contractor: ��(1T�c_. Contact Person: <br /> o�,a l O�, <br /> Address_ ��7 Z7 Je4�,n�,n � State License#: � �S� ( �� <br /> �� � � <br /> City: shwl�o�kC. Zip: Expiration Date: <br /> Phone: �SZ ' L.'�1 Z �� �b� Alternate Phone: �S� - z�S-��S�7�S <br />