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��, � <br /> �a��SE ONLY <br /> /!�0/�/� City of Orono [r�ce xeceiv �; Perm�t# <br /> P.O.Box 66 <br /> ` � 2750 Kelley Pazkway ❑In-House SAC Detummahon Form Co�leted <br /> � Crystal Bay,MN 55323 <br /> '.`c'� (952)249-4G00/Fa�c(952)249-4616 Approved By(If Required): <br /> 'ti�,��„v-�� <br /> CITY OF ORONO-SEWER&WATER/GENERAL PERMIT <br /> ('�Note:Some permits may require approval by the Building Official and/or Public Works DepaRment•) <br /> (Ai,L PERMI7'S- Mav be subiect to further rev(ew and mav nat 6e issued when tde aoolicatlon is receivedl <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 pernut card is avaitable on the job site. <br /> 5. Utility coanection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locarions. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without eapress <br /> approval of the Pubtic Works Department. Issuance of a pemut 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 reqaired. <br /> TYPE OF PERMIT <br /> Check All T'hat A 1 <br /> �Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑New Connection ❑Additional Connection ❑Re-Connecrion ❑Repairs �isconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: ����� J � � r��1� 'J'� <br /> Owner: �� v��� Mailing Address: �L��� / V ��h� "'� <br /> c�ri: C�rbt�� zip: ��53� I <br /> Home Phone: Altemate Phone: 1�" <br /> Contractor Information: <br /> Contractor: ��'�� ��_��� Contact Person: ����� <br /> Ada�ss: l I�l�l � l�t� \J State License#: <br /> City: 1���� Zip:���_I� Expiration Date: <br /> cl -� G t <br /> Phone: J�1-�J�— I�� Altemate Phone: <br />