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IJ ONLY <br /> Q11 /r,0 City of Orono Date Receivid: / ,Permit# pe j/7`� <br /> P.O.Box 66 <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 /)1 �TJ <br /> <,r . <br /> ' (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 /> (ALI.PERMITS- May be subject to further review and may not be issued when the annlication 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 he 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 /> 'W Residential(May Require Approval) 0 Commercial(Approval Required) <br /> 0 New Connection 0 Additional Connection 0 Re-Connection 0 Repairs Alpisconnect <br /> 0 Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: P S 0 . r t a• �'A .1 <br /> Owner:C j'C 1 ►/KS . Mailing Address: �2)312- -k- Blvct. <br /> City: V EUI. Zip: 55 S f 1 <br /> Home Phone: Alternate Phone: (D( 2 999•:SO { Fe <br /> ( Contractor Inffoormaation: / <br /> Contractor: ,�t.,l'l�bey (1). Contact Person: . c�Y ¶cJ't _ <br /> Address: 1-��( �7"h�(JState License#: <br /> City: CCACCA CLVI. Zip 7 4Expiration Date: <br /> Phone: (1019; <br /> gt2-.1'I03 Alternate Phone: (0(„2•• ''2_L <br />