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08/21/13 12:17 OLSONCONSTRUCTION 9524485289 p.05 <br /> , S�tG d� ��2- 005�� <br /> P s�2 !� <br /> 1 <br /> FOR C1TY USE ONLY <br /> ;.����r,•, City of Orono nace Received: Pennit� <br /> P.O.I3oa 66 <br /> 2750 Keiley Patklvay �Io-Housc SAC llecerminution Poan Completed <br /> �� � :. Crystul f3ay,MN 55323 <br /> '!`,�Y'� , (432)249-4C� APProved By(If Roquired): <br /> '���l�u�' ' <br /> CITY 4F ORONO—SEWER&WATER/GENERAL PERMIT <br /> ("Plote:Some permits may require apprcrval by tho I3wlding Official end/or Puhlic Wurks I)epar�nent'1 <br /> LLL PERMITS Mav be subiect to farRher revkw and mav pot be f9�ued whca the anolicatiau b receiv ) <br /> GENERAL INFORMATION <br /> 1. You may appty for utility permits hy mail or in person at the City offices. <br /> 2. Mailed in appiications are subject to the postage and handling fee shown befow. Permit cards will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are not valid unt�you receive a permit cxrd. <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-buih locatians. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without eapress <br /> approval of the Publie Works Department. Issuance of a permit dces not grant this approval. <br /> 7. Atl work must be done in accordance with State Code requirements. <br /> 8. AIl work must be inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> TYPE OF PERMTT <br /> Check All That A 1 <br /> �Residential(May Require Approval) ❑Commercia!(Approval Requiral) <br /> ��New Connection ❑Additionat Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection Fot Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: ,�„�� ��.�7�� ����. <br /> 4wner:��'"11`�� ��(�D .1.�. Mailing Address: �'�?� �l:�'j'�'�'F��-�1�,,��'.' �,,,� <br /> ! �j <br /> City: :C'��', `�.r�f,l�.l Zip: ��t3�� <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ��;5�� ��'],,`�'�` Contact Person: �(/Y�;�(''� ��,�(�1'7 <br /> t� �Z� � �� y <br /> Address: t�/°�t� -�h�p�r�l�,.1 State License#: �����[�j,3 �' ,} �/-',�'��'���r <br /> ;..� � <br /> City: �(�;� � Zip• xpiration Date: <br /> Phone: �J�-����'--,�,(��lJ���l Atternate Phone: ����� <br />