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. . . <br /> � <br /> F�, CI USE ONLY . / <br /> 4�� City of Orono Date Received;� 2 Permit# �D/a—p /'f`� <br /> P.O.Box 66 <br /> ��;,ti,�,,a � 2750 Kelley Parkway ❑ In-House SAC Determination Form Completed <br /> ' a ;�j'�?���' Crystal Bay,MN 55323 <br /> �1t�. � <br /> � '?t.,���s,�C.yo (952)249-4600 Approved By(If Required): <br /> ��Hp6 <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 aon��cation 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 Apply) � � <br /> �f 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: 3� 1'� r/R�-�e.�wc5e,c�, f�d � <br /> Owner: �.d R l �Ntu lsanl Mailing Address: S �i w.� <br /> c�ty: t�v�y�-��-� z�p: �5 39l <br /> Home Phone: 9S�" �13'd22) Alternate Phone: <br /> Contractor Information: <br /> Contractor: M USI��q ��U wcbi� Contact Person: �n��c��Y V'OS�(Z <br /> Address: I�18rJ a.�ke.�.as� �lde• State License#: b�C7'�Cf-"�1M. <br /> c�ty; ��e�i I le Zip:�S/�Expiration Date: ��,""3�"' �b�� <br /> Phone: J-,�S (-`�g�b-f�(�5,(, Alternate Phone: _ �� 1�'�3(- ')�5 <br />