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4111 <br /> c w OE ONLY Ol] � <br /> 4 �6City of Orono Date itesewed: P t# �"`° <br /> P.O.Box 66 <br /> 2750 Kelley Parkway 0 In House-SS .0 Determwation form Completed <br /> k"r;„1t <br /> Crystal Bay,MN 55323 <br /> (952)249-4600 Approved.E+; Auluired). <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT 45 ` °p <br /> �' � <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"ITORMATION <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 /> TY E� i <br /> t :. t '� <br /> `(Clerk A11`.f.'hatApply) 4 . ' <br /> Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection ❑Re-Connection a Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job,Site/:Owner Information: <br /> Site Address: 3 cc? I C of C�r.sZ <br /> Owner: C 3 07 _ ` /Lt,,�^ Mailing Address: � 1O7 71/66(Aja <br /> City: w� Zip: SST i <br /> Home Phone: 6 ( l `t' ( Alternate Phone: <br /> Contractor Iiformat <br /> Contractor: j-4( K V K) P(6 .3 - Contact Person: b <br /> Address: y3()( E-(t6H0 J PL- State License#: Q <br /> City: TK YS Expiration Date: /.2/3/36 / <br /> Phone: 6(2 S -1V--OYy y Alternate Phone: j 1- `l33 W 6 0 3 <br />