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FpR CITY USE O1�1LY <br /> „�(�� City of Orono DateReceived: Permit# <br /> O Q P.O.Box 66 \ <br /> 2750 Kelley Pazkway ❑In-House SAC Determination Form Completed <br /> � x;.� Crystal Bay,MN 55323 � <br /> �y (952)249-4600 Approved Bq(If Requiredj: <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 subiect to further review and mav not be issued when the aoolication is received) <br /> GENERAL INF�RMATION <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 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 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 reqnired. <br /> TYPE OF PERMIT ' <br /> Check All That A 1 <br /> �Residential(May Require Approval) ❑Commercial(Approval Required) <br /> � New Connection ❑Additional Connection �Re-Connection �Repairs ❑Disconnect <br /> Job Site/Owner Information: <br /> Site Address: /���p '� ►�G r-� �� �,��4 �f: <br /> Owner: �>� 'J��^�, Mailing Address: ���`^ 2 <br /> ���: o n�� � Z�p: � �3 a 3 <br /> Home Phone: �s � '��a-���� Alternate Phone: �/� 2^SO �' 6 a S � <br /> Contractor Information: <br /> Contractor: �� � ,, �n�1Q/l ��``'��� �¢ 5� �/c�nS o`�J� <br /> G�ntact rcrson: <br /> Address: �d�01 P,�f� ��` State License#: <br /> � a <br /> City: � 1 � Zip: �3 Expiration Date: <br /> Phone: `� >� " �`'� I` �� g `i Alternate Phone: �91 )-� J �c ! `�'� j � I <br /> 1 <br />