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\ FOR crrY USE ONLY <br /> 7- D City of Orono Date Received:'-- <br /> P.O.Box 66 a. l if Permit!1 Z Uj -oE23 <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> ,t-/ Crystal Bay,MN 55323 <br /> \�r'ricesaoss,c, (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 /> (ALL PERMITS- May be subiect to further review and may not be issuedivbea the afolication 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 /> SZT New 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: dB? 6/c' ,t -d Zci, <br /> Owner: D/4ViO WM'`Ii Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> •Contractor: L),S,A1, tkz.-�i9ti,Vb /Contact Person: /moi 461-/Are/.4 <br /> Address: Sn g/t / k3`V Xikt , State License#: <br /> City: "/A/Sy%N1.S Zip:C�33 Expiration Date: <br /> Phone: 4.Y /PP./3j Alternate Phone: G/eQ, fly. 93 /3`" <br />