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ilik <br /> , i'1‘576 <br /> ) ` 41t15E ONLY <br /> ,„0A4, <br /> 1-4104.1 <br /> City of Orono Date Recce 11 - Permit# � �!; P.O.Box 66 <br /> 2750 Kelley Parkway In-House SAC Determination Form Completed <br /> ,�-J Crystal Bay,MN 55323 <br /> 1�4 ,„,sHo¢``G` (952)249-4600/Fax(952)249-4616 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 sublect to further review and may not be issued when the_anolication 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 PER IT . <br /> (Check All That Apply) <br /> aResidential(May Require Approval) ❑Commercial(Approval Required) <br /> 0 New Connection 0 Additional Connection 0 Re-Connection 0 Repairs ('Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: �7� �f`p Kv 0fCt4V Cl led t <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: fOK 4S a(,) Contact Person: 71‘ c'i CIc,/s � <br /> k <br /> Address: tar CD• 4115 State License#: <br /> City: ou'^d ZipS t Expiration Date: <br /> Phone: 9c-Z--f 7�-1 S Alternate Phone: bi'2- ?q/-�T 77 <br />