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'1 <br /> FOR�CITX IISE 01aTLY <br /> ,���, City of Orono Date Iteceived; Permit# <br /> Q� O P.O.Box 66 , _ <br /> 2750 Kelley Parkway ❑In-House SAC Detemiinatiori Fomi Completed . <br /> � �.� Crystal Bay,MN 55323 <br /> � (952)249-4600 Approued By(If Required�: <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 PERMI7'S- Mav be subiect to further review and mav not be issued w6en t6e aoolication is received) <br /> GENERAI;INFOR1VIAfiION <br /> 1. You may apply for utility permits by mail or in person at the City o�ces. <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 Sta.te Code requirements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> T�PE OF PE�N�.IT � <br /> ' ' (ChBck�11`Tfiat A . 1 s <br /> �`Residential(May Require Approval) �Commercial(Approval Required) <br /> �New Connection ❑Additional Connection �Re-Connection <br /> �Repairs ❑Disconnect <br /> Job'�ite/Ownar Info�nation: '. <br /> Site Address: �%��J v � : S o�,P „ <br /> Owner: f�`i� lr.r.�-��,.l� �c�,�wO� Mailing Address: <br /> City: �G•-:��, cc�. ��� Zip: <br /> Home Phone: Alternate Phone: ��� -���-�d'7� <br /> Contra�tor:Informatiari: ''' <br /> Contractor: � �C � l Contact Person: J�S o-�. �r,,.rd�1�� <br /> Address: �. S��a�D�"�r�P State License#: _�����o�-(�� <br /> City: ,���C o �''1�/ Zip: SdZo Expiration Date: <br /> Phone: ���`����.5��� Alternate Phone: C��l P c �-����� <br />