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� <br /> ' FO�SE��NLY <br /> �,¢0�� City of Orono DateReceiuedf� Gt Permi�#����" ��7 <br /> P.O.Box 66 ' T� <br /> 2750 Kelley Parkway ❑In-House SAC Deteimination Fmm ComQleted ' <br /> � � ,, � Crystal Bay,MN 55323 <br /> �o� (952)249-4600 Approued$y(If Required): <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 aoalication is receivedl <br /> GENERAL.Il�TFQI�MATTON ' <br /> 1. You may apply for urility permits by mail or in person at the City offices. <br /> 2. Mailed in applicarions 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. Urility connecrion pemuts 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 egpress <br /> approval of the Public Works Department. Issuance of a perxnit 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 PERIVIIT "= <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 /> Joli Site/Owner Information: <br /> Site Address: �d NL.,��_(T�� i�C <br /> Owner:(tii�r/L���;��c n,� Mailing Address: �r� �1 <br /> City: or,�n�� Zip: <br /> Home Phone: 95u��y7`�••0�� Alternate Phone: �Sdd-���7����`� <br /> Contraetor information: : <br /> Contractor: �•c�,�p,` ��,L�,-e,�,�te( Contact Person: (��+-1 � <br /> Address: �b�{ C�.,,r�;.� �� State License#: �7�,o�,o -�'�'1 rL <br /> City: Wct,{C(.I��,�n _ Zip:5�3� Expiration Date: 1 a -��- � <br /> ¢ <br /> Phone: `�5� `�S��-l5�4� Alternate Phone: �,�o�,- S n�. ��;C� <br />