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� • ___-�,, <br /> / k'O�SE ONI,Y <br /> �/ ��'O�` City of Orono Date Recei�+ Permit# ���'��' �� <br /> P.O.Box 66 <br /> i 2750 Kelley Parkway ❑Jn-House SAC Detecrnination Porm Cnmp1efed <br /> 4l^y ,,�1 Crystal Bay,MN 55323 <br /> ��'��"tsrro��i� (952)249-4600 Appra�edBy(IfRequired): <br /> \__�- <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department•) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoolication is received) <br /> GEI�TER�L INFORMATIQN <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)far 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 dF PERMIT <br /> '�����(Chec�A.�l�"hat 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 /> 7ab Site/Owner Info�matic�n: <br /> Site Address: 1�S ��"�-z" �"�-s <br /> Owner: ���� ��` Mailing Address: ��� Zsf`` ��-'�"`�p <br /> �� Cc��� •�r. -��3c�3 <br /> City: Zip: <br /> I�o�e�h��: �i Z- ���-S 7 7�7 Alternate Phone: <br /> Con�ractor Inf�rmation: ' <br /> Contractor: �LC�G�. � Contact Person: �C�GE'� f 1(I(f'�-5 <br /> Address: � 5� ��J� ✓�'U`e �Y State License#: <br /> City: � (��� Zip:����-3 Expiration Date: <br /> Phone: Alternate Phone: <br />