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RECEIV�C� <br /> �o-.,, M A Y � '� 2 O�� FOR CITY USE UAIT,'Y G} <br /> � n!Q City of Orono ��M Dateitaceived: P�rmit#�1?- ' �� 7 / <br /> P.O.Box 66 <br /> 2750 Ke►ley Parkway ❑In•Hause SA�Detertnittatipn Form Cpmpleted <br /> y ,� Crystal Bay,MN 55323 CITY 4F ORONO <br /> '°r ��� (952)249-4600/Fax(95L)249-4616 ApproVed By(If Required): <br /> qA� SHO� . . � . . <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 aonlication is received) <br /> GENERAL INFORMATIQN <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 pernut card is available on the job site. <br /> 5. Utility connecrion permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Deparhnent(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 QF PERMIT <br /> Check Al1 That A 1 <br /> ❑Residential(May Require Approval) ❑Commercial(Approval Required) <br /> �w Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site f t)wner Information: <br /> Site Address: �`1 �' ��� � �i<=V-'G--�--'`-� � � <br /> Owner: V`��a���� �-� Mailing Address: <br /> City: �t'��^-G Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Infoz�rr�ation: <br /> J <br /> Contractor: '3v(I�.� <<�.,J� S o.� 5 Contact Person: �� ��-�l'�' <br /> Address: �1 H U 1 C. ��l 3 State License#: '�b �� Y y �3 <br /> City: ������^S Zip:��� Expiration Date: � Z-- 3 , " ��' <br /> Phone: `�S Z- ��� ���3 Alternate Phone: ��2 �S 11 2`t S� <br />