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� <br /> ��g`O.ArO \ y Fo�cr�u��orn,� <br /> � Cit of Orono Date Received: Pumit# <br /> �' � P.O.Box 66 <br /> ; 2750 Kelley Parkway ❑In-Ho�tse SAC Determination Form Completed <br /> ���, � �-�' Crystal Bay,MN 55323 <br /> '� G� <br /> \'���s�io�-j �952)249-4600/Fa�c(952)249-4616 Approved By(I2'Required): <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permiu may require approval by the Building Official and/or Public Works Departrnent•) <br /> (ALL PERMITS- Mav be subiect to furt6er review and mav not be issued when the auolicedon is receivedl <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 pemut 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 Department(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 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 inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> TYPE OF PER.IvI�T <br /> Ch,eck All That A i <br /> ❑Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connecrion ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Joi� Site L Ovvner Ir�ormation: <br /> Site Address: ��;� � ��1�, r�'� f I ��c'_ ��-� t�f� � <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractar Information: <br /> ` � � ����� � <br /> Contractor: ���,C_,�S �.XC�, Contact Person: <br /> � > > <br /> Address: 7�"O i.`' �L�{`' ��� State License#: �� �5�--� <br /> , <br /> City: C��-n �ciSSt!1 Zip:SS�I� Expiration Date: ,��'/c� <br /> Phone: �;��(��-��'�7`� Alternate Phone: �1�02- `-f��n -��7`� <br />