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� <br /> • EOR CITY USE ONLY <br /> ��� City of Orono DateReceivedi . Permic# <br /> O P.O.Box 66 , <br /> �"< 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> a� ���> �-��, Crystal.Bay,MN 55323 ' <br /> �+�'���`i�,�a�o� (952)249-4600 Approved By(If Required): <br /> �goa <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 PERMITS- Nta be sub"ect to further review nnd ma not be issued�vhen thc a lication is recci ed) <br /> GENERAL INFORNIATION _ <br /> 1. You may apply for utility pennits by mail or in person at the City of�ces. I <br /> 2. Mailed in applicatioiis are subject to tlie postage and handling fee shown below. Pemut�cards will <br /> be sent by rehirn mail within 2 busuiess days. <br /> 3. Permits are not valid until you receive a pernut card. <br /> 4. Work must not begin unless the peinut card is available on the job site. <br /> 5. Urility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locarions. <br /> DO NOT EXCAVATE IN ANY STR.EET 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 iiispected before it is covered. Call(952)249-4600,24+hour notice required. <br /> '< TYPE OF PERIVIIT; : ; . <br /> , , � <br /> , <br /> -: (Clieck All That�A .�,,,lY) ', ., , <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: ���������- �� <br /> Owner:� t� ��.�/��- Mailing Address: Z����� <br /> City: ��� ��� Zip: ���'J` � <br /> Home Phone: �S Z �f 73��G� Alternate Phone: <br /> Contractor Information: <br /> Contractor���,,.< ����e�ontact Person: ��..��� ����-� <br /> Address: ,/�� �'/�� State License#: f�� / <br /> City: �t����� Zip:��3Expiration Date: �..z� ,�/ � � �. <br /> Phone: 7C 3 ��7 �G �{� Alternate Phone: � /Z g/ � ��—f .,�e � <br />