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FOR CITY USE ONLY <br /> /�(��\ City of Orono Date Received: Yennit# <br /> P.O.Box 66 <br /> ��,�,� �� 27�0 Kelley Parkway ❑In,FIouse SAC Determination Form Completed <br /> �,�1` C stal Ba <br /> � ���' �;�' �,�' �Y Y,MN 5�323 <br /> ��,�o��o i (952)249-4600 Approved By(If Required): <br /> `�-...__: <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some pennits may require approval by the Building Ofticial and/or Public Works Department*) <br /> (ALL PERMITS- N(av be subiect to further revicw and mav not be issued when the aoplication is received) <br /> GENERAL 1NFORMATION <br /> ;. l. 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 handlii�g 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(ocations. <br /> DO NOT EXCAVATE IN ANl'STREET AND DO NOT TAP ANY MAIN without express <br /> approval of the Public�Vorks 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 A 1 <br /> �Residential(May Require Approval) � Commercial(Approval Required) <br /> �New Connection ❑Additional Connection �Re-Connection �Repaics �Disconnect <br /> Job Site/ Owner Information: <br /> S ite Address: � ! J ��'��\ ls�1�1 e <br /> Ownec: e�l c.�C7 (�1 Mailing Address: <br /> City: �D(\c( L.C��e Zip: . 5�.��:� <br /> Home Phone: ��c�—�OC(—�(��� Alternate Phone: <br /> Contractor Information: <br /> Contractor: actl� ��f�`�� Contact Person: �Gl��P ��o� <br /> Address: r7NS ��U�P��7�/e State License #: <br /> City: �./��U�O Zip:�/3Expiration Date: <br /> Phone: �aa� r63—SC-�3 Alternate Phone: 76 3 "a��� 36Y9 <br />