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/Ol-"Or) <br /> 4a.AJNCity of Orono Date Received 07 'enmit# /&-OQ(p <br /> ilific... P.O.Box 66 <br /> j 2750 Kelley Parkway 0 In-House S C Det 1 1:;on Form Completed <br /> e-) Crystal Bay,MN 55323 <br /> io.., sr►oac c. (952)249-4600/Fax(952)249-4616 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 subieet to further review and may nothe issued when the aonlication 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 /> 0 New Connection 0 Additional Connection ❑Re-Connection 0 Repairs [ J Disconnect <br /> 0 Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 'J CgSCo A rot £0J <br /> Owner: G°f1c4t1 -11"br`e-S Cs"tS f, Mailing Address: <br /> City: 0 form Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: (•;✓'o l in S ,e,- 'I- t✓gFe/ Contact Person: Dere{ NtIALto <br /> Address: 77 c Ta`"e'- D,-4'e- State License#: <br /> City: HA'^'lcAZip:$53`to Expiration Date: <br /> Phone: (3.12- '119- 06 7o Alternate Phone: <br />