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f <br /> � <br /> .-�-'_.�, FOR CITY USE ONLY <br /> �f=����!��-�� City of Orono �ate Recei�ee: Pern,it� / <br /> P.O.Box 66 <br /> ;a Y� �} 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> ` Crystal Bay,MN 55323 <br /> ' �, ri�*`'� �✓j (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> ;;�-'.�r:-�"' <br /> CITY OF ORONO— SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permiu�nay requue approval by the Building Ofl�icial and/or Public Works Department*) <br /> (ALL PERMI7 S- Ma��be subiect to further review and ma�not be issued when the application is received) <br /> GENERAL INFORMATION <br /> 1. You may apply far 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 wil] <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-Connection ❑Repairs ❑ Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: !��� � �� �L .��' <br /> �� , '/�_ <br /> Owner: ���� ������ Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: .J•f��i�1.YJ`Z ��i�1C�L1 Contact Person: C/ � ���- <br /> Address: ����<%1������Z�Z� State License#: ���r� ����� <br /> Ciry: ��L��k��'� Zip:��j��Expiration Date: ���-,���1� <br /> Phone:����-�����J Alternate Phone: <br />