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�ON�\ City of Orono Date Received:/i, i b o?O/�f_Q i oZ�D <br /> P.O.Box 66 <br /> ) 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> s, t Crystal Bay,MN 55323 <br /> ��'ArSHo¢``�`11L- <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 subiect to further review and maYPot be issued when the aDolkatioon is received) <br /> GENERAL L IIVFORMATIOI <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 /> (Y4 New Connection 0 Additional Connection ❑Re-Connection 0 Repairs 0 Disconnect <br /> 0 Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 76 ,r ac.,) (c,e. ,_.. lUG a qc c3 .k.)4"--- <br /> Owner: <br /> "-'Owner: Mailing Address: <br /> City: Zip: <br /> s <br /> Home Phone: lEe - Alternate Phone: <br /> Contractor Information: <br /> Contractor: (-Xc3((t -6 ),LS Contact Person: <br /> Address: ((`I° ( Cc) C< 3 State License#: <br /> City: c'Sl,S ZipSSSo1 <br /> Expiration Date: <br /> Phone: ?S-2- 73R --x(33 Alternate Phone: <br />