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7Ll(y <br /> —� FO CI USL 5 0 <br /> City of Orono Date Receive Permit Permit mit## �f� <br /> P.O.Box 66 <br /> i , 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> y Crystal Bay,MN 55323 <br /> oo (952)249 4600 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 /> (ALL PERMITS- May be subject to further review and may not be issued when the aoalication 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 /> ❑ New Connection ❑ Additional Connection ❑Re-Connection ❑ Repairs ODisconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site /Owner Information: <br /> Site Address: 3 510 Nog4�p g�) AV P— <br /> Owner: pG4>J 90 U +��� Mailing Address: 5ci ov% e— <br /> City: 6QoUQ Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: LL)e-! O►. 414 64-W Contact Person: rN1k; C'L4:;Qf-- <br /> Address: State License #: 13 1 633 6 98 <br /> City: Zip: IMO Expiration Date: <br /> Phone: 4040 Alternate Phone: <br />