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.� <br /> f + <br /> FOR I ifSE ONI:Y <br /> ��� �� City of Orono Date Received: E Pe,mit# tZO� "`b <br /> P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAG Detemjination Form Comp'ted <br /> ��t 'Y� Crystal Bay,MN 55323 <br /> � (952)249-4600 Approved By(If,Required): <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERMIT II <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (.�LL PERMITS- Mav be subiect to further review and mav not be issued when the aunlication is receivedl <br /> GENE L 1NFORMATIQN ; <br /> 1. ou may apply for utility permits by mail or in person at the City offices. <br /> 2. ailed in applications are subject to the postage and handling fee shown below. Permit cards Ilwill <br /> l�e sent by return mail within 2 business days. <br /> 3. Qermits are not valid until you receive a permit card. <br /> 4. �Vork must not begin unless the permit card is available on the job site. <br /> 5. � tility connection permits may be issued to licensed contractors only. <br /> 6. ontact the Public Works Department(952-249-4600)for utility stub as-built locations. <br /> O NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without expr ss <br /> approval of the Public Works Department. Issuance of a permit does not grant this approva . <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 requir d. <br /> TYFE OF PERMTT <br /> ` Check All That A 1 <br /> ❑Resic�ential (May Require Approval) ❑Commercial (Approval Required) II <br /> ❑ New�onnection ❑Additional Connection ❑Re-Connection ❑Repairs c.�Disconnec <br /> � ❑ Water Availability Connection For Future Hook-Up to Water �I <br /> Job Site Owner Information: li <br /> , /��"5" S�� <br /> Srte Add�`ess: r� .� <br /> Owner: ,�'7'aw���` � � /�,�" Mailing Address: 7� U<<�t �J; ��� <br /> City: ��- o'�� L c�. Zip: .S��T�C li <br /> Home Phpne: `'7SZ" <<�3 - 3 SL� Alternate Phone: ��2 _ .��3 . I���� <br /> `Contracta Inforrnation: <br /> Contracto <br /> r: /���!/ r�.�.�f Contact Person: �!�� i` <br /> �. <br /> Address: I S/ / l���i�3 State License#: �� '� ��„� <br /> City: i �tif Zip:� Expiration Date: �/a�L <br /> Phone: I �.� - 93�y�.33 Alternate Phone: �J�y� 7 ° � <br />