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� FOR CITY USE ONLY <br /> O��j�� City of Orono Date Received: p��# <br /> 'r� P.O.Box 66 <br /> y�,.� 2750 Kelley Pazkway ❑In-House SAC Determinafion Form Completed <br /> � J�MrA� Crystal Bay,MN 55323 <br /> S��:y�,� (952)249-4600 Approved By(If Required): <br /> ��� <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require appmval by the Building Officiai and/or Public Works Department') <br /> (ALL PERMITS Mav be subiect to further review and mav not be issued when the applicallon is received) <br /> GENERAL INFORMATION <br /> I. 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. Perrnit 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 ttie perxnit cazd 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 ezpress <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 PERNIIT <br /> Check All That A 1 <br /> ❑Residential(May Require Approval) ❑Commercial(Approval Reyuired) <br /> ❑New Connection ❑Additional Connection �Re-Connection ❑Repairs ❑Disconnect <br /> Job Site/Owner Information: —� <br /> Site Address: ,���� �i>j"%i'► ���LLI"��1��' <br /> Owner:�l������'/�C�D f Mailing Address: Srr'�i� <br /> City: �ti��t v�it TA Zip: <br /> Home Phone: Alternate Phone: n ����-���-��� <br /> I�QL�t°I��G�A/"I�Pi�'��'!��� <br /> Contractor Information: <br /> , C � • f <br /> Contractor: ���4_��%'��Y�veGti�' Contact Person: <br /> Address: ��U � � rt State License#: ,_�r���� <br /> City: ��� ��✓ Zip:��y� Expiration Date: <br /> Phone: �p��—%�—���� Alternate Phone: `,�/-�:����y <br />