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• <br /> i <br /> 74, '\ <br /> '\ , , USE ONLY _ G <br /> OHO` •City of Orono Date Received: 181 permit# LA)lip -bC <br /> P.O.Box 66 <br /> l 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> l} f Crystal Bay,MN 55323 P�// Z�D� <br /> \ � 17 <br /> ,C (952)249-4600/Fax(952)249-4616 Approved By(If Required): t`s i))Zc,1 <br /> He <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 /> gl New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑Disconnect <br /> 5e,,,,Q,' 0 Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 1 p o C o rvz L J <br /> Owner: l 1,k-Q- Q��h, Mailing Address: Aue5 <br /> City: M;nnnr,(a© S Zip: SS`A4S <br /> Home Phone: 01--16c‘ 3 9 6 Alternate Phone: <br /> Contractor Information: <br /> Contractor: n Q f.N. SQu...V W oaf t Contact Person: e;, (-o .n <br /> Address: LU 6Li k,.A State License#: . 7 3 aq- nv c <br /> City: WoLer n Zip:Scygi Expiration Date: <br /> Phone: (- ' Soc3 -el(V14 Alternate Phone: <br />