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i( <br /> FOR CITY USE ONLY <br /> Clty of Orono Date Received: Permit# <br /> O4 % P.O.Box 66 <br /> 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> a 4,,,,,1� , Crystal Bay,MN 55323 <br /> �'t so` (952)249-4600Ntessolv <br /> Approved By(If Required): <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 ' 4 ! `l <br /> f , <br /> (Check All That Apply) <br /> Et Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> New Connection ❑Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: 19 0 ©(20 N 0 <br /> (Zt ID-c D <br /> Owner:,().--)k t---Li)1M c .2j(moi— Mailing Address: 3‘S 030OpiAtL <br /> City: 604'-{ i".A Zip: S S "3 9 <br /> Home Phone: Alternate Phone: '-- <br /> Contractor Information: <br /> Contractor: (A)1 ILA C..30 Gos �4 c Contact Person: ��`C. MI Mitt <br /> Address: IRC f{i. N, 3(2 State License #: 5 G 46,E <br /> City: 5� PI c.L- Zip:5-Sl(99 Expiration Date: .3 / 0 C_ <br /> Phone: &5I 4' O Alternate Phone: c'I-2- 3�3 4-4-2 I <br /> Ti 1 <br /> 3 <br /> 3 1 1 <br />