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v <br /> - City o1� FO E ONLY�7 <br /> Orono Date ReceivedPermit# a?O, zd 70 <br /> P.O.Box 66 Al4114 <br /> 2750 Ke ley Parkway0 In-House SAC Determination Form Completed <br /> Crystal ay,MN 55323 <br /> ,/,, r1 " � (952)24 -4600/Fax(952)249-4616 Approved By(If Required): <br /> CITY OF ORONO-SEWER&WATER/GENERAL PERMIT <br /> (*Note:Som 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 apjlications 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 areof valid until you receive a permit card. <br /> 4. Work must n t begin unless the permit card is available on the job site. <br /> 5. Utility conne tion permits may be issued to licensed contractors only. <br /> 6. Contact the blic Works Department(952-249-4600)for utility stub as-built locations. <br /> DO NOT E CAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express <br /> approval of a Public Works Department. Issuance of a permit does not grant this approval. <br /> 7. All work mu be done in accordance with State Code requirements. <br /> 8. All work mu 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 isconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 2 c r c n e 'O i-cLa r c -, `--/ `- <br /> Owner: )J I la- L\a,4,-1S Mailing Address: <br /> City: "-7-- _it ...rt.-4 Zip: <br /> Home Phone: - ' --7 5 3- 7 S QAlternate Phone: 62/ - a 8 .)-- 70 i 4 <br /> Contractor Inform.tion: <br /> Contractor: . a., L w1--v" Contact Person: a.Z}-tvp <br /> Address: ' ---7 3o 1 u-k. "1 %1-- State License#: <br /> Av w <br /> City: 3ctv1 4 i Zip: , ,;o4'OExpiration Date: <br /> Phone: (p 1�- -626N-- 7337 Alternate Phone: <br />