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,�' � , <br /> �. FOR CITY USE ONLY <br /> r'��4-�`�'�'�. City of Orono nate Recaived: � rarmit# <br /> % P.O.Box 66 <br /> � � 2750 Kelley Parkway ❑In-House SAC Detemtination Form Completed <br /> �,. i � � Crystal Bay,MN 55323 <br /> �`Y`�'., 1 (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> '�.'f�l;c yi C+d'',.. <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERNIIT <br /> (*Note: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 not be issued when t6e suolication 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 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 permit cazd 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 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. Cail(952)249-4600,24+hour notice required. <br /> TYPE OF,PERMIT <br /> Check All That A 1 <br /> �',Residential(May Require Approval) ❑Commercial(Approval Required) <br /> l� <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: ��S� /U��� ��,,� J�' <br /> Owner:�ti,n,/�ti �-1a�� Mailing Address: <br /> City: /}�U+/t � Zip: <br /> Home Phone: 7���C/�/7—/Z52 Alternate Phone: <br /> Contractor Information: <br /> Contractor: J.a Sr,Liv��� �2✓�Contact Person: J�� SL��TL <br /> Address: �6C/S� /���"� ��`lState License#: <br /> City: �.r,�c. Zip:���' Expiration Date: <br /> Phone: ��s;��� Alternate Phone: �1G, 3���/?-LZ.��. <br /> �G� Z rG- � � 5� <br />