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FOR CITY USE ONLY <br /> sL0 ` City of Orono Date Received: -s'$ Permit v �L'1v2 <br /> P.O.Box 66 <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> ytiii, <br /> ) Crystal Bay,MN 55323 <br /> ke s�i o¢_v (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> v- <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 aanlication is received) <br /> GENERAL INFORMATIOl <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 PER?' IT <br /> (Check All That Apply) <br /> Q Residential(May Require Approval) 0 Commercial(Approval Required) <br /> 0 New Connection ❑Additional Connection Re-Connection 0 Repairs ❑Disconnect <br /> 0 Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: o�C (0S Cots (0 fo),f- Ri <br /> Owner: °(-r " )`1141e-1 Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ( ro'ILL CeLier t- L'y/Cr Contact Person: 0e✓c(� /(iik(- 0 <br /> Address: 77C T L'"'r 10,-fv-e- State License#: <br /> City: l-1-,,,v1e.J Zip:-55171-0 Expiration Date: <br /> Phone: (,(/),- 1/ 40-70 Alternate Phone: <br />