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FOR CITY USE ONLY <br /> (4...0Ab City of Orono Date Received: �ermit#o� 7—� 3 <br /> P.O.Box 66 <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> s h Crystal Bay,MN 55323 <br /> lithIP <br /> tc, (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> �kFSHOP�. <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 subject to further review and may not be issued when the application 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 ❑Additional Connection ❑Re-Connection 0 Repairs rJ Disconnect <br /> 0 Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: :3G(,O AJU/Z71-1 tai)32L, L)R.,1 /L <br /> Owner: !'-f tC/414 L 5#-4 i D7-1- Mailing Address: 31,5116 ItJUIZy}.i 5NDPL A121(115- <br /> City: <br /> /tJ&City: LUiay E11-174 Zip: —5 S34)/ - <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: L(.TZIL A . ..j . Contact Person: STi C. Etc-iZAt) . <br /> Address: 3'-170 I Z/ State License#: �' <br /> ('v ,QLIZ??F%1 /pipa / <br /> City: ) _ Zip:5j3f1 p Expiration Date: <br /> Phone: (4 -Z.) 9 S .1/ .- Alternate Phone: (/,iz) (// S - 1-/30, <br />