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r <br /> FOR CITY USE ONLY <br /> City of Orono Date Received: Permit# <br /> / ,„ "V P.O.Box 66 <br /> �• 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> aj ,�? Crystal Bay,MN 55323 <br /> (952)2494600 Approved By(If Required): <br /> �+txo <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 it—Additional Connection ❑Re-Connection 0 Repairs ❑Disconnect <br /> Conr,ec4 5ew¢r +o hDu:.)e From c,-r4`C <br /> Job Site/Owner Information: <br /> Site Address: In(-15 n ict Lori cs 1,.c(Le 12A, <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: Mc<nctke p10 64- r' Contact Person: .bid u `S <br /> Address: )15 25 (fir t h C;r c I e State License#: OCD C 3 P0-2 <br /> City: 6‘ .v lest (et kc Zips Expiration Date: / 2 ' 3l — O 6 <br /> Phone: (Q( 2--75( ` 117 7 Alternate Phone: Ste,rr,e <br />