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_. <br /> �` <br /> .FO$CLTY USE ONLX ' <br /> ,¢�� City of Orono Dat�Received: Peimit# <br /> P.O.Box 66 <br /> ��- � 2750 Kelley Parkway ❑In�House SAC Determination Form Completed ; <br /> � z ,v� Crystal Bay,MN 55323 , <br /> ��o� (952)249-4600 Approved Sy(If Required): <br /> a <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Deparirnent'") <br /> (ALL PERMII'S- Mav be subiect to further review and mav not be issued when the aoalication is received) <br /> GENERAL INFORIVIATION = <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Urility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without e$press <br /> approval of the Public Works Department. Issuance of a pernut 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 /> ° T'YPE OF PERIVIIT ' <br /> (Check All That APP1Y) ' ' <br /> ��Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑New Connection ❑Additional Connecrion ❑Re-Connection ❑Repairs �Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Informa�ion: <br /> Site Address: ���� ��`�� � �`°''� ��'��e <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: ; <br /> Contractor: (�t�S�O��`- S�� Contact Person: ��iG,� C �� '1 <br /> Address: r C�, ��. �S State License#: j�`��� <br /> City: ���� Zip: -J�.�y Expiration Date: 12���' �� <br /> Phone: ��-�(7�- �� � Alternate Phone: � �� 7���- �7�� <br />