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''' ` _ ���, ,,� <br /> . <br /> ; �� �,��G <br /> . � <br /> . ���� ; .� ;. <br /> ,1 , : <br /> ' �``G�i ^��' FOR CITY USE ONLY <br /> �:. � <br /> O,¢O�O City of Orono _t' ^•.� \ DateReceived: Permit# <br /> P.O.Box 66 � �' <br /> s�,`�,' 2750 Kelley Parkway ❑ In-House SAC Determination Form Completed <br /> a����� � � Crystal Bay,MN 55323 <br /> ��i�.�o` (952)249-4600 Approved By(If Required): �` � <br /> asxo$ � �v `'�,� <br /> U� <br /> CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT �, ;��`' 1 �" �� <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) � '`�V' \� <br /> (ALL PERMITS- MaV be subiect to further review and mav not be issued when the application is received) � � <br /> \ <br /> GENERAL 1NFORMATION ' <br /> 1. You may apply for utility pernuts 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 pernut 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 Deparhnent(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 pernut 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 Apply) <br /> ❑Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> [�New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑Disconnect <br /> <� <br /> Job Site/ Owner Information: �� � � <br /> Site Address: l�?i; �' [ �>;��' �) �%�a�% <br /> Owner: ��.�� �i Gh��y/� Mailing Address: <br /> City: � Zip: <br /> Home Phone: ��'`3 y ��"- ��'2� Alternate Phone: <br /> Contractor Information: <br /> , i� � �� s ,,L Y— _ , '% <br /> Contractor: �%�� S```�• � Contact Person: ��`��� �''� ����� <br /> , ���_,�,.�� c ' /� �:3.��� <br /> Address: /1�1���I'��j-��'r' � State License #: 2G3c�� l �s� � �/z/ �f <br /> �T � , <br /> City: Zip: Expiration Date: �� � ��� y �� <br /> Phone: Alternate Phone: <br />