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, _ <br /> ��\ Ci of Orono ����O�"� <br /> tY Date Recei�ed: Pu�it# <br /> ; P.O.Box 66 <br /> ; 2750 Kelky ParkwaY O In-I�ousc SAC <br /> s, ,�'� Crystal Bay,MN 55323 D����on Form Completcd <br /> ``�'���sHo�-```` (952)249-4600/Fau(952)249-4616 Approved By(IfRtquircd�; <br /> CITY OF ORONO—SEWER&WATE12/GENERAL PERMIT <br /> (*Note:Some permits may require approvai by the Building Official and/or Public Works Depaztrnent+) <br /> (ALL PERMITS- I1LV bt cnhi�wt*n fnrfh*r��virw snrt ine.�...�.':'_.._a...�__.+.----��--� <br /> GfiI�iERA�,IlVFOR2►�ATIOI� _ <br /> 1. You may apply for urility permits by maii or in person at�e City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Petmit cards will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are not valid until yon receive s 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(952-249-4600j for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAI1V 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. Ca11(952)249-4600,24+hour notice required. <br /> T1'PE OF PER�T <br /> Chec�All That A ,. <br /> ,[v�Residential(May Require Approval) ❑ Commercial A roval Re uired <br /> � PP 9 ) <br /> ❑ New Connection ❑Additional Connection ❑Re-Connection ❑Repairs [�Disconnect <br /> ❑ Water Availability Conne�rion For Future Hook-Up to Water <br /> Jo�i Si�e/Ovi;ner Ir�a�ation: <br /> � / �� �`� <br /> Site Address: �7 � ( ,� �,t�i�� <br /> Owner:_�� ) � �"t "�; � Mailing Address:.�l�l�, r� 0 , L-�^,�I�i� �/'��� <br /> City: ���/�!')✓����� Zlp; � 1.�rj <br /> Home Phone: Alternate Phone: <br /> Contractor In�ormation: <br /> Contractor� �J�� �;e�.J � ��. -��7��' Contact Person: Q�1�►^� Yl� � �(�v� <br /> Address: ��S`�l'� � �,1� '�' �- . �'� ���� State License#: ������) �� <br /> City: �►^ �. Zip:�Jj����Expiration Date: �� 3i 1 � <br /> Phone: ��� ��,3��7� � Alternate Phone: ���-6��� � � � <br />