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I" g ,, <br /> O 0 City of Orono Date Roceiv ��l <br /> P.O.Box 66 <br /> 2750 Kelley Parkway Q In-House SAC Determination Form Completed <br /> � Crystal Bay,MN 55323 <br /> l,�AssHo.4 <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 s) <br /> (ALL PERMITS- May be alibied to further review and may mainlined when the sooie tlonis rewind) <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+hoar notice required. <br /> TYPE OF PERMIT . <br /> (Check All That Apply) <br /> rtl Residential(May Require Approval) 0 Commercial(Approval Required) <br /> New Connection ❑Additional Connection ❑Re-Connection ❑Repairs 0 Disconnect <br /> 0 Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 62 5 °? 6 0 // v r////l <br /> Owner: / 5 ji/ 4 Mailing Address: ..02.2; ti 0 &cid i?l o1 <br /> City: La. lie v 7/ Zip: y5/ <br /> Home Phone: ?SO?- 5/6 9- yo te to <br /> Alternate Phone: <br /> Contractor information: <br /> Contractor: 6//es groc, (1:1(C . Contact Person: A 0 r 'H ‘•,/.0-j <br /> Address: `7//47 vc" 4/ State License#: re LeL53SI <br /> City: / )4`'a rk Zip: 6-&-o 5 <br /> c/,u cExpiration Date: .1?//5/17 <br /> Phone: Alternate Phone: CP /02- 3 0 b-"/77 <br />