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O FOR CITY U5E ONLY y� ��1 <br /> � N� City of Orono Date Received: � _/ "„V Permit# � .�(J <br /> � P.O.Box 66 (� <br /> � �1 � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> 1:'\ Crystal Bay,MN 55323 <br /> .��, � (952)249-4600/Fa�c(952)249-4616 Approved By(If Required): <br /> ���/�11 ilF'l <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 sabiect to further review and mav not be issued when the aoolication 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 belo:-,-. Pc,::.::c;.:�':.�:::: <br /> be sent by return mail within 2 business days. <br /> 3. Permits are not valid until you receive a F�r::::�c�ra <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 Warks Department(952-249-4600)for��t�l�t;�sr���e-t."=': �...�;.':_.:,._ <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. .°::-.:c:!:::act be�'cne in accordance with State Code requirements. <br /> � .:t ___ _�. -'----.t...............�...�1.AF.��.�t ic rn.�nrP�, C'�lI�Q571?t}Q_dfiQn,�q+h.,�i��oticQ rQquired. <br /> TYPE OF PERMIT <br /> ��h���- ��r �rr.�. �,..,�.., <br /> �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: ���� Y V� �� ���t?'�� ��+ '��i <br /> r \ \ � <br /> Owner: ;� �'► 1�01� �i C.�Y��Mailing Address: �=e +�if�� <br /> � <br /> City: (r�rC? it11� Zip: <br /> Home Phone: E��� ,���� Alternate Phone: � <br /> Contractor Information: <br /> Contractor: I�t�(�, ���^+�^��� Contact Person: ��� ��W����� <br /> SqqC� V'�1�.�x� C.�, <br /> Address: � ���i��� State License#: <br /> � \ <br /> City: �`��C `(Jl,�.� Zip����xpiration Date: <br /> Phone: �� Z. ��"1, � 7�) Alternate Phone: G�Z - Z� �6�� <br />