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c <br /> IP. d4 <br /> FOR CM,USE ONLY "'° <br /> City of Orono Date Received:/-3/7 perish QW/ Q9Ovt-. <br /> P.O.Box 66 <br /> 2750 Kellry Parkway ❑In-House SAC Determination Fonn Completed .',� <br /> stsic.4-04/c--- <br /> ,J Crystal Bay,MN 55323 <br /> tcsNoa�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 subject to further review and may not be issqed when the aapllcation is received) <br /> GENERAL INFORMATION <br /> I. 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 /> 7 Residential(May Require Approval) ❑Commercial(Approval Required) <br /> ❑ New Connection 0 Additional Connection tgt Re-Connection ❑ Repairs ❑ Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 5 90 O'OnQ Ol(.t Imo. <br /> Owner:) ' wile]\D ( ,A,(i . Mailing Address: ki <br /> City: WOle Zip: n vt <br /> Home Phone: Alternate Phone: (Q .2 .% 3 b2Co() <br /> Contractor Information: - <br /> Contractor: 466. 1l <br /> a ) I Contact Person: ?1,111. VA-1101.0d1 , <br /> Address: ‘20��1J'l,i�k lti 1i1 State License#: <br /> City: Zip 41 Expiration Date: <br /> Phone: 116 )tO1/t07 Alternate Phone: <br />