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Jul 01 2013 09:29AM Matts Plumbing Solutions 7637842204 page 1 <br /> FO CI ON4Y � <br /> � EL�/�IU City of Orono Date Received:�� � 'tt► 0?�!3 r � <br /> P.O,Box 66 <br /> '�{� 2750 Kelley Parkway ❑In-Houu SAC Detem�ination FamCompkaed <br /> �\! � � Crystal Bay,MN 55323 <br /> r� !�'�,,•�� (932)249-4600 Approved BY(If Reqtsired): <br /> "��n�+t <br /> CITY OF QRONO—SEWER&WATER/GENERAL PERMIT <br /> (•Note�Some pemuts may require apprioval by the Building Qt�cid and/or Public Works Department•} <br /> (ALL PEIiMI7'S- Mar be subi ect tg turther nview ind mav nat be ieaued wbea ttie aoutleation�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 subj ect to trie postage and handling fee shown below. Pern�it cards will <br /> be sent by return mai)within 2 business days. <br /> 3. Permits are not valid unHl 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 pemuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Deparhnent(952-249-4b00)for ulility stub as-built locationa. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN wiWout express <br /> approvai ot the Public Works Department. Issuance of a perniit dces not grant this approval. <br /> 7. All work must be done in accordanCe with State Code requffements. <br /> 8. All work must be inspected before it is covered. Call{952)249-460U,24+honr 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 �pairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Tnformation: <br /> Site Address: T�7 ! ��/'�l �L�i �, � <br /> To M Ne So� � <br /> Owner: � Mailing Address: ��(1yt,+,sz <br /> c��: oroNo Z�p: :�cu��� <br /> Home Phone: � � " ��( Alternate Phone: LCi�I,��l.�. <br /> Contiactor Information: <br /> , , � <br /> COnti°actpr: A ' • l�1 Ll�jG1lSContact Person: 1�`.1'����Z�(��� <br /> Address: �J�".`� } ��'-f i�' .± '' ;�U-% State License#: ��'�' L���,'�„�Z, � <br /> City: Zip:�:f•:X� Expiration Date: 1"L� < I f c�. <br /> Phone: �ir�r".,��'� l"J�5��?�j Alternate Phone: ��i::3 -?. i c �� �) <br />