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a91(l-00g5� <br /> FOR CITY USE ONLY <br /> City of Orono Date Received: / P ��'t# /1� <br /> P.O.Box 66 1 <br /> 2750 Kelley Parkway 0 In-House SAC a et a ion Form Completed <br /> y 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 /> k\e <br /> GENERAL INFORMATION ri /ft <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 /> 2 New Connection El Additional Connection El Re-Connection El Repairs ❑Disconnect <br /> El Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: pp <br /> Site Address: 6 25" O 1) l/ <br /> 6n 6k, Rj <br /> Owner:-II I4,7j Mailing Address: <br /> City: 0 N0'1 o Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: Q / <br /> Contractor: t:-/' v - s' 71-z . Contact Person: ri <br /> Address: Cl/2. ( d c 4'( S6. State License#: 2/ 9. <br /> City: Qc Ic.1 o Zip:.S5J2.. Expiration Date: <br /> Phone: 76 3) 21-2-Y-2-0, Alternate Phone: ail )L2 2) Co 9 <br />