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`4 <br /> F CIT US ONLY�y �1 Z Q 9 <br /> ���� City Of Orono Date Rxeiv�� �ennit# v'+i L�--C/ <br /> P.O.Box 66 <br /> I 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> i , Crystal Bay,MN 55323)1,4" <br /> (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> str pov-` ` <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) 0 Commercial(Approval R ired) <br /> ❑New Connection ❑Additional Connection ❑Re-Connection Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site I Owner Information: <br /> Site Address: l ORDn-4 0✓C1,41c f fi---/. <br /> Owner: JO-P._ R.C.)/a-e_ Mailing Address: 5r ' '- - <br /> City: (J, `O Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: (,9Ecrys J - 1A H Contact Person: C2____ y G#'c.-.rc..-el/ <br /> Address: /fWo �iG ,t f _J /OrState License#: eVt.0 Co 20 S 3 <br /> City: )04001c/ Zip:55-Z4/ Expiration Date: /Z -V-' ( 4 <br /> Phone: F57-Z 4'a- yG 3 7 Alternate Phone: q-rZ"2-Y0-62W 7 <br />