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FO�SE ONLY <br /> ��/V� City ot Orono Date Received Pennit# Q - <br /> Y.O.Sox 66 <br /> � 2750]:ellcy Parkw:iy ❑ln-House SAC Dztermination Form Completed <br /> � � Cry�tal Ba�,MN 5>3?3 <br /> .,�i.�`��` <br /> (952)249-4600/Fax(952)2�9-4616 AFfpro�ed By(lf Keyuired): <br /> CITY OF ORONO-SEWER & WATER/GEIER�L PERMIT <br /> (*5ote:Some permits may require xpproval bV the Ruilding Of(icial and/or Public Works Depwiment*) <br /> (ALL PERD9lTS- D1av be subiect to further review and mav not be issued wl�en the application is receivedl <br /> GENERAL 1NFORMATION I <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> �. Mailed in applications are subject to the postlge and h�ndling fee sho�vn belo�v. Pennit cards��-ill <br /> be sent by return mail�i�ithiu 2 business days. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work nmst not begin uiiless lhc permil card is available on the job site. <br /> 5. Utility counection pernlits may be issued to liceused contractors only. <br /> 6. Contact the Public Works Depariment(952-249-4600)for utility stub as-built locations. <br /> DO I�OT F,XCA�'A7'E IN A'VY STREI�;'1'ANll DO N07'7'AY ANl'n1AIN��ithout express <br /> approval of the Public Works Department. Issuance of a pennit does not grant this approval. <br /> 7. All work must b�done in accordance tvith State Code requirements. <br /> R. All work must be inspectecl before it is covered. Call(95�)?49-4600,24+hour notice required. <br /> TYPE OF PERMIT <br /> (Check All That A 1 ) <br /> ❑Residential(\�[ay Require Approval) [✓YCominercial(Approval Requircd) <br /> ❑Ne�-Connection ❑Addilional Connection [�Re-Connection ❑ Repairs ❑ Discorulect <br /> ❑ Water A�ailability Connection }'or I'uture l-look-Up to Water <br /> Job Site/Owuer Information: <br /> Site Address: Z,'�3D K�L���t �A�c��k� <br /> ()wner: C�r�t oF �eoao MailingAddress: Z73o CFceEv t�'a�.t��Y <br /> City: ��F,�sTq� �Ay Zip: �53z3 <br /> Home Plione: 4�1-L�(9-�/60o Alternate Phone: <br /> Contractor lnformation: <br /> Contractor: M�a�/ESorA Uri�iri£s �*EX��r�ContactPerson: �ec � � 1aK1 <br /> Address: �3q3z ��+� De�v� State License#: / �, G1ta� <br /> City: �o¢fsf Lq�E Zip:55oZ Expiration Date: Ot�D��/y <br /> Pllone: 651-�/6y '�5 3 Z Alternate Pl�one: (�Z-ZZ 3- 308y <br />