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~A FOR CITY USE ONLY. <br /> Q•y 15 — <br /> City of Orono Date Received: Permit# `70 <br /> P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> t Crystal Bay,MN 55323 <br /> (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 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 /> ❑ 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: ')_11C)U ow r . k Orbr'o } fy)pj <br /> Owner:SSV^ l CU+eZ Mailing Address: <br /> City: (36C1n0 Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: 1`o <br /> Contractor: U/',liN4 .L.4. Contact Person: �e�a /S��E�►-� <br /> a <br /> Address: -/i -P.. Em=45 SvJ State License #: <br /> City: o1vrj Zip:-5 -�3 Expiration Date: <br /> Phone: -7-40"�. ,3 Alternate Phone: <br />