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. � . <br /> FOR CITY USE ONLY <br /> -���^/� City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> ``' 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> i\ � , Crystal Bay,MN 55323 <br /> � �s'�� (952)249-4600/Pax(952)249-4616 Approved By(If Required): <br /> ,�A/�i:,��H, <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 is�ued when the auulication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pennits 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 Warks 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 A 1 <br /> ❑ Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> � New Connection ❑Additional Connection �Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Fnture Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: `���'� � S t�J ��E�� �� <br /> Owner:(�Cv,�\��I A �ic����� �T('�� Mailing Address: �{ � S�,�c��,;� z,.,�J !�y <br /> City: (���c:�h zip: S Sy� �s <br /> Home Phone: �a.�3(�,q-�c���� Alternate Phone: <br /> Contractor Information: <br /> Contractor: Cc;��r. ��_� ,,,;�1�Q( Contact Person: g:�� �,P o� n <br /> Address: `z�tb`-i &.k�.� .,,.<v,� State License#: �`73'�.'�- M(Y <br /> City: �,�� ��,,� Zip:�� Expiration Date: `�a,-3�- �� <br /> Phone: L\�--50�-`iq7�t Alternate Phone: <br />