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� <br /> � �-----.� FOR CTI'Y USE ONLx,� �{/ <br /> ,�-��10� City of Orono Date Received: �J11_� Permit# z- l���9 — �v� <br /> i <br /> �•, P.O.Box 66 °�� ���� <br /> � ' ( ` 2750 Kelley Parkway ❑In-House SAC Detennination Form Completed <br /> ,��� ,Z-�` Crystal Bay,MN 55323 <br /> \;\�t.�¢%/ (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Departrnent•) <br /> (ALL PERMITS- Mav be subiect to(urt6er review and mav not be issued wheo the aualicallon 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 aze 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 cazd is available on the job site. <br /> 5. Urility 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 That A i <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: �3 0 �y� � C- <br /> `" � f�� <br /> Owner: ��c YV� s��C� Mailing Address: ��� ZS� r/� � <br /> City: �� C'�/lv� zip: �j^� 30� <br /> Home Phone: �(� 3�'� �f� �GJ�� Alternate Phone: <br /> Contractor Information: <br /> Contractor: ''/ LC-�' l� �� Contact Person: �G%��/�/�� ��� <br /> Address: ��J����'`����C�K�State License#: 1����� 2� <br /> J�� �3n <br /> City: �//�G�l`'� Zip: Expiration Date: <br /> � <br /> Phone: �7���Y ���C/ Alternate Phone: <br />