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' 3 <br /> FOR CITY USE ONLY <br /> 0 .0AO City of Orono Date Received: Permit# <br /> P.O.Box 66 <br /> 2750 Kelley Parkway 0 In House SAC Determination Form Completed <br /> u• • Crystal Bay,MN 55323 <br /> `el' (952)2494600 Approved By(If Required): <br /> CITY OF ORONO—SEWER&WATER/GENERAL PERMIT <br /> (A 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) in Commercial(Approval Required) <br /> ❑New Connection ❑Additional Connection 0 Re-Connection In Repairs Disconnect <br /> • Job Site/Owner Information: <br /> Site Address: a SO 0 rota o 0 r C h a rd k d . S_ <br /> Owner: bah New I 'a v/< T-st Mailing Address: -7105 (o r/o ra•fe Dr- PTX- C-3S <br /> O8anlrywrde lkm� l-oans: <br /> City: Plane,, TX Zip: ' 50 <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: Pe+e's Wa fey£5eivev;J.► Contact Person: J a vi e- <br /> Address: g'0 0 Lo v y ,Mie• NE• State License#: 3?/SS 9 3 <br /> City: 1 p/S Zip:fy,,, Expiration Date: // .,/o q <br /> 5-5 41 <br /> Phone: /2 - '7 F9- (e/ Z Alternate Phone: 6.f 2 —36 3 - /2-37 <br />