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. <br /> FOR CITY USE ONLY <br /> O (� O City of Orono Date Received, Permit# <br /> P.O.Box 66 <br /> "� 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> . Crystal Bay,MN 55323 <br /> i'I t` , <br /> i (952)249-4600 Approved By(If Required): <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- May be subject to further review and may not be issued when the application 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 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 required. <br /> TYPE OF PERMIT <br /> (Check All That Apply) <br /> ®Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ® New Connection ❑Additional Connection 8 Re-Connections airs <br /> p E Disconnect <br /> Job Site/Owner"Information: <br /> Site Address: 11 0 1 0 1)0 V `, I r e C) T' <br /> Owner: 7r-1 OP—C o`J en clJ O r Mailing Address: LIO LE D r 'Co k-L��-t ,r w,- <br /> City: a c,3 o Zip: S—E3 b L <br /> Home Phone:CI S L t-7 Lf-ko Li 0 Alternate Phone: <br /> Contractor Information: <br /> Contractor: QC Q \(V Contact Person: '^Gtt C C' <br /> Address: L( n c _1 \ - State License#: 7 — L S <br /> City: 01, K he\e: s\c Zip CC3Sy Expiration Date: ` r)-, 3 \ - ©, <br /> Phone: (0 I-). `+-0 Lo 0- ")- v Alternate Phone: <br />