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_ �\ FOR CITY USE ONLY <br /> �'Q.�1�1'� � City of Orono Datel�eceived:�� Permit# <br /> P.O.Box 66 ' <br /> 2750 Kelley Parkway ❑In-House SAC Deter�nination�'arm Completed <br /> ���, `�� Crystal Bay,MN 55323 <br /> �`" �/ (952)249-4600 Apprn�ved By(If Reqc�ired): <br /> ��Acst�o�j, <br /> _.._-� <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- Mav be subiect to further review and mav not be issued when the aoolication is received) <br /> GENERAL Il�tFOI�.MATICON ' <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 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'PERMIT <br /> (Check All T�t 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 /> 7t�b Site/Owner Information: <br /> Site Address: ��6(� ��`�in�r..,50�n �.�2 <br /> Owner: ,�e,u�il �t�-� Mailing Address: Sv�� <br /> City: ��?J�'t,v Zip: �S�cl/ <br /> Home Phone: Alternate Phone: G��38'7'��a�' <br /> Contraetor Information: ' <br /> Contractor: �2n i�i.���t �2n���h P��b��Contact Person: /I�prr�i L?cw�� <br /> Address: [ El���r� ,�- /(/ State License#: S��(> � <br /> City: /��h�t ,s Zip:�/ Expiration Date: ( �� ���l.3 <br /> Phone: �{�?,-�-�(S-`�4hQ Alternate Phone: G j a--�6 ?-Q'4� <br />