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t � <br /> FOR CITY USE ONLY 3�� <br /> �-.��-���`4��, CiTy of Orono �ace Recei�efl: Permit#�l ��f <br /> � P.O.Box 66 <br /> � ) 2750 Kelley Parkway ❑In-House SAC Determination Fonn Completed <br /> ,� �� Crystal Bay,MN 55323 <br /> �- r� '�`� �� ,�� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some pennits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- �la��be subiect to further review and ma��not be issued when the aonlication is received) <br /> GENERAL 1NFORMATION <br /> 1. You may apply for utility permits by mail ar 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. Wark 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. Contaet 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 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/Owner Information: <br /> �`��.�� " <br /> Site Address: ���� !2��1��� �L��'Tc��-- <br /> Owner: /�� /�6�y��i�� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor:-.�i�, �7 !6 (�'t� ��C.- Contact Person: `�l ��� ������_ <br /> Address: �� ���� //Z/�/T1 State License#: ���y�,�F�� <br /> City: ����l.C/ �� " Zip: ����Expiration Date: f�'�( /,� <br /> Phone: ��fi3��C/� �! �(L� Alternate Phone: <br />