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1011512015 16:14 FinalGrade TAX)952 492 5101 P.0021003 <br /> 'd <br /> FOR C T .USE ONLY <br /> �L-O'\I City of Orono Date Received; L(�(l i �rmic p �b��J' <br /> P.O.Box 66 1 <br /> 2750 Kelley Parkway In-House SAC A alio Form Co�nplaced (�66�' `i <br /> IF- Crystal Bay,A0 yf(` �al �J v" <br /> �`' snow"`, (932)249.4600 Fax{952 249-4616 Approved By YRequ d): taco.0 <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 /> ' :U IN- U' U. i t ia' . it IC i i i .. I sip I f1 .CII, . 1. <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 arc 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 ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: aS 35 >� c) <br /> IA: weer '7-1: 1. Mailing Address: G-16. /..3c.,,a L4 <br /> City:4422,_,_621„,-.4,„2 Zip: .-14JS59 <br /> Home Phone: Alternate Phone: ' l&- 4I 't-//7 <br /> Contractor Information: <br /> Contractor: Contact Person: 42z2224.4) ;xite,..4__., <br /> Address:197�'I aiid eL State License#: J1/I ' <br /> c56City: Zip: Expiration Date: <br /> Phone: 9 d"" ' k.".��dO Alternate Phone: d.41-.?9" 299 <br />