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POR CITY USE ONLY <br /> ic-01-1\t,-, ; P.O.Box Orono Date Received: Perfl»t sl <br /> 1 2750 Kelley Parkway <br /> 0 In-House SAC DadTnmation Form Completed <br /> a ;'I Crystal Bay,MN 55323 <br /> l�AE3 H 04'� (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 subleet to farther m and mai not be asaed <br /> GENERAL INFORMATION , . : J <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 /> (Cheek All That Apply)_ . <br /> 0 Residential(May Require Approval) ❑Commercial(Approval Required) <br /> New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> 71. <br /> 0 Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Inflation: <br /> yOgili <br /> Site Address: /8'37 4e/54/ted tiftX <br /> Owner: Mfrio Medd" /4*ire/ Mailing Address: <br /> City: 4v0 Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: LLc* a.6411PCilt. keContact Person: 4/ier to ,r i v J <br /> Address: 294 6i 7',e/ot ,4 . State License#: <br /> City: 71L`1J1%44.S Zip:ssa33 Expiration Date: <br /> Phone: toS-' V8a. /3 Alternate Phone: ‘,/P y/ 9. 4/.3ya- <br />