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abAl <br /> zstI1 E OM, j ...•N \`, City of Orono Dater % Pennit•_ �!;r '� J-7111'' , `' <br /> ! illp `'. P.O.Box 66 • 'w <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completes <br /> silc,, <br /> . 1 Crystal Bay,MN 55323 <br /> r,! t` �' (952)249-4600/Fax(952)249-4616 Approved By(If Required): ,41-14S <br /> lt+ "- e•••°4R4HC) - - 60 <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERMIT , <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) 61 <br /> d\ <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 /> 4' TYPE OF PERMIT <br /> (Check All That Apply) <br /> 0 Residential(May Require Approval) ,ommercial(Approval Required) <br /> giNew Connection ❑Additional Connection 0 Re-Connection 0 Repairs ❑Disconnect <br /> 0 Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: V50 O/) Cry ( 1.3•7 Rd <br /> Owner: feel rec,I^rltc-w\ Mailing Address: <br /> City: 0 roil O Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: 1/'oSon Pivitn,6,-I Contact Person: 6(4 7 <br /> Address: /51 S_4 5 5 -' 5 State License #: yam"" pm G nt 4 c <br /> City: flop r} Zip: SS 3`t-3Expiration Date: /.2,- /5- <br /> Phone: <br /> sPhone: c7c74. -(t38 "?3' Alternate Phone: (/2^ f' —a'OZ 7 <br />