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FOR CITY USE ONLY <br /> �oNo City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> �" FS H o E��. (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> �� �.! <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERMIT r <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- May be subject to further review and may not be issued when the application is received) <br /> c�0�� <br /> GENERAL INFORMATION <br /> � <br /> 1. You may apply for utility permits by mail or in person at the City offices. C/T5, 'fi�014 <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will OF p <br /> be sent by return mail within 2 business days. 4�/1/d <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)2494600,24+hour notice required. <br /> TYPE OF PERMIT <br /> Check All That Apply) <br /> Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ,r Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: (16 go N• S ko <br /> Owner: ky'Le Mailing Address: 3 <br /> City: V N r'e�-P CAA /� ^1 / Zip: S_<_3 1S c� <br /> Home Phone: Alternate Phone: `7 6 3 2ft — C7 C6 <br /> Contractor Information: <br /> (�� 5 ``Con�tralctor: �G'v` Contact Person: v 4 �,AC <br /> Address: 1 I '�__CotJ S6VecA- State License#: <br /> 11 _ I t3lo•1Pt <br /> Zip <br /> City: C �`" I�flk e :51;30y Expiration Date: <br /> Phone: 7 6 - t(314` 3 1-1 9 q Alternate Phone: 6 A <br />