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� <br /> ! � -- <br /> Ffl CI USE ONLY �/ <br /> O�Q�,� City of Orono Date Recetved.�: � Femut# ��II—� : �O <br /> P.O.Box 66 ' <br /> ° 2750 Kelley Parkway ❑In-House SAC Determuiarion Form Completed <br /> Crystal Bay,MN 55323 <br /> � `' �o� (952)249-4600 Approved By(If'Required): <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERNIIT <br /> (*Note:Some permits may require approval by the Building O�cial and/or Public Works Department'") <br /> (ALL PERMITS- Mav be subiect to furt6er revtew and mav not be issued when the aoalicatian is receivedl <br /> GENERAL IN�ORMATION <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 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 Staxe Code requirements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600,24+hour aotice required. <br /> TYPE OF'PERIVIIT <br /> ' Check A11 That A 1 <br /> �esidential(May Require Approval) ❑Commercial(Approval Required) <br /> '�Tew Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> � ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: _`[� [) �v "� J `�� �1 � <br /> ,�---� <br /> Owner: 1 l� �o v�P Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information:; <br /> Contractor: W�����S S!� Contact Person: F°�`� ����� <br /> � � <br /> Address: ��� �� �S State License#: � �`�to <br /> City: ��l°� Zip:���Expiration Date: <br /> Phone: �oZ�?�-C��� Alternate Phone: ��Z" ?��-g��S <br />