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t . � <br /> FOR CITY USE ONLY <br /> ,��� City of Orono Date Received: Permit# ' <br /> P.O.Bos 66 <br /> ��;,.,,,, O 27�0 Kelley Parkway ❑Tn-House SAC Determination Form Completed <br /> ��'���;;� � Crystal Bay,MN 55323 <br /> ����'��+-,�.�o` (952)249-4600 Approved By(If Required): <br /> sexo$ <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*;Vote:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav�ot be issued when the annlication is received) <br /> GENERAL 1NFORMATION <br /> 1. You may apply for utility peimits 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 pernut card. <br /> 4. Work inust not begin unless the peinut card is available on the job site. <br /> 5. Urility 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 express <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 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 /> _��_q_� � 3 c��► `1 n <br /> Site Address: >tio-�i�-' ��'��`� i L�v� 1J��- <br /> � <br /> Owner: ��'2� ���`'"i�`� Mailing Address: <br /> City: C� "JZ-�-%wv Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: L/}{LS6� , `""`� �`�- Contact Person: �`�k `-"��'� <br /> Address: �3 U�{S 1 b�n� 1.�� State License#: L�� 33�'� 1 �� <br /> City: ������+`� Zip: �'�r� Expiration Date: 1��3� �0 5 <br /> Phone: �I�' 3 �l- `����fi Alternate Phone: �G� '� L�'��� � <br /> � t u �g�, �� <br />