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H <br /> FOR CITY USE ONLY <br /> iO'\o City of Orono Date Received: Permit# <br /> \ P.O.Box 66 <br /> �, 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> j=\t 4-/ Crystal Bay,MN 55323 <br /> \'".4 ,�C/ (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> \Atsuo¢j <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- Mav 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 /> (hi 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: --?-?g 6 A/A V a r(/"co_ 2.—./1 "UP D/C'n o <br /> Owner: Mailing Address: <br /> City: Ode A. a Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: v <br /> Contractor: Contact Person: 9S — oS /'(AS?2-7 <br /> Address: 7& l/o r-S77 State License#: L 33 2 <br /> W <br /> City: C01/1 4‘,63e11Zip:5- 1/Expiration Date: s- `8 <br /> Phone: 95-a ! 9(O ai) Alternate Phone: 96-A- . p �,3'72( <br />