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FOR CITY�SE ONLY nv�/�y <br /> O,���O City of Orono Date Received: 1 l�'v'> Permit# � <br /> P.O.Bos 66 <br /> �; 27�0 Kelley Parkway ❑in-House SAC Determination Form Completed <br /> ���>�;e r � Crystal Bay,MN 55323 <br /> ��^ �T��M�.�o~ (952)249-4600 Approved By(If Required): <br /> ��sxa� <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 /> (.4LL PERMITS- Mav be subiect to further review and mav not be issued when the anolication is reccived) <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. Pernut 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 pemut card is available on the job site. <br /> 5. Utility connection perinits 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 espress <br /> approval of the Public Works Department. Issuance of a pennit 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 /> (�.Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: <br /> ,��y5 ��2/C��'�,�,� �� � ���rno <br /> Owner: �j t SS��t 5�-�"�'�-°� �1VIai1 ng Address: <br /> City: (_�'/�K.0 j'(.(� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> � C � � <br /> � <br /> Contractar: �:� - C���Le��42/ C ��� Contact Person: ` �s5 ���G <br /> a �� ��� <br /> Address: ��� /� �`� State License #: <br /> City: �`%��n``e t � Zip;��3s7Expiration Date: <br /> Phone: ��3`"`���-�7�� Alternate Phone: <br />