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f �' �taSy� C�S�1L W32x/'^� . �►'�-� <br /> �� - F�O/�USEONL�I� ���0 <br /> �' � /VD City of Orono Date Received /C�Pennit# <br /> P.O.Box 66 <br /> I 2750 Kelley Parkway ❑In-House SAC Determination Fonn Completed <br /> �� � ,� Crystal E3ay,MN 55323 <br /> �� ��� (952)249-4600/Fas(952)249-4616 Approved By(If Required): <br /> �fKFSNOC,�.. <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some pennits may require approval by the Building Official and/or Public Works DeparCment*) <br /> (ALI.PERMITS- Mav bc subiect to[urther review and mav not be issued when the application 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 /> 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 contractars only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built►ocations. <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 wark 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 A 1 ) <br /> ❑ Residential(May Require Approval) ❑Commercial(Approval Required) <br /> �New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: i Z `�� 1 i� � i�....�_ . '�"i .S a.S ��n����� <br /> Owner: Z�.``•��..ti-- �,'� -•��� Mailing Address: `! `r�� ��v�)�z� j (c S <br /> City: t�l� �)�.�� Zip: 5��3`P � <br /> Home Phone: �.`�� '�� 3 � �`� ? Alternate Phone: <br /> Contractor Information: <br /> Contractor: `- � �,�.�._._ ,,. ,-�-_ �. ,. -��-, Contact Person: i)��.�� - <br /> Address: ��'_ �. 3��r 3��- State License#: �--��S � �-- <br /> Ciry: 1��,���. Zip:`��>>''S 3 Expiration Date: �� °� Z�� � <br /> Phone: � �L�- ?C� Z �;7� Alternate Phone: (..�S l — )j� b% � - <br />