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� �, � <br /> . <br /> __----- <br /> 1�OR��i�ST UI�fiLY <br /> $-�NO�� City of Orono DaceReceived: ' Pe,a�itl� ZOl6- O T7Q� <br /> ; P.O.Box 66 <br /> `J 2750 Kelley Parkway ❑In-Iionse SAC Detertnination Form Completed <br /> � ,�-% Crystal Bay,MN 55323 s <br /> y`'�'���sHo¢``G` (952)249-4600/Fax(952)249-4616 Approved By(Tt'Itequired): <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Departrnent►) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issaed when the aoolication is receivedl <br /> GEI�iERAL INFORMATIOl� _ <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 pernut 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 sdib as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without eapress <br /> approval of the Public Works Department. Issuance of a permit dces 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 PER�vIIT <br /> Clreck All That A i <br /> ❑Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑New Connecrion ❑Additional Connection ❑Re-Connection ❑Repairs „ja'Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Si�te/Ov�er Ir�o�ation: <br /> Site Address: � 1 g� /v��� �'j��� IJ r 1.U2� <br /> Owner: �l�G���l �L��s� � Mailing Address: 1 �31 S�ou��,� zT' <br /> c�ri: � 1 y��vYl� ZIP: ss`��7 <br /> Home Phone: �I�Z��o�- ���� Alternate Phone: <br /> Contractar Information: <br /> Contractor: � dKl� Contact Person: � , �r.•������ <br /> Address: �7/� f��CG� /����d� State License#: Z�U S�� Z� <br /> City: �r�o�G��P Zip: 1`�3�Expiration Date: <br /> Phone: �J 7�y�7��f�l Alternate Phone: <br />