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� ' <br /> . <br /> FOR CITY USE ONLY <br /> �=yt�—���1.f���. City of Orono Date Received: Permit# <br /> j+ J '' P.O.Box 66 <br /> ,j_ � I 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> a , Crystal Bay,MN 55323 <br /> ;` '��. �� (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 E3uilding Official and/or Public Works Department*) <br /> (ALI.PGRM[TS- Mac be subiect to further revieN and mac not be issued when the application is received) <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 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 That A 1 ) <br /> Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> �New Connection ❑Additional Connection ❑Re-Connecrion ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: /L��� ���/���Fi �����-� <br /> Owner: �u'T� /��if' � � ,�L'� ` Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: �1:� ��/2�� �'��1�" Contact Person: ".������ �� <br /> Address: ��T�J� /���/��1� State License#: t�t����� � <br /> ,�1 � -� } <br /> City: �'�/'I�`���4��� Zip:���Expiration Date: / � �� <br /> Phone: �GJ�I G�%� l�-/ Alternate Phone: <br />