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(��� I <br /> - O FOR CITY USE ONLY <br /> ' �L- /�l��� City of Orono Date Received: Permit# <br /> r P.O.Box 66 <br /> �� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �� �� ' Crystal Bay,MN 55323 <br /> l"� < (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> ., <br /> -,"�K��s t�c�r�/ <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 aonlication 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 A 1 ) <br /> �Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑New Connection ❑Additiona(Connection ❑Re-Connection ❑Repairs ❑ Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: �U ��`� �+(�" ' � r�D� � �� <br /> Owner: G�(T�"►',Gt✓� Mailing Address: S I`��� <br /> City: V`�0✓�U Zip: S_`�.3�l � <br /> Home Phone: �? E Z ' S I `� ' Z Z`� � Alternate Phone: <br /> Contractor Information: <br /> .� <br /> Contractor: ��t'�nf,;,���ua��o�-� Contact Person: �avh �����r,�.Z- <br /> �r Cxcc.Je-k;r� , Inc� <br /> Address: �zo�'��� �,�,;�-e.�,�1 L�� State License#: � <br /> City: v`� Zip:� Expiration Date: <br /> Phone: �j����/�?g" �d�G '- Alternate Phone: <br />