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��� A` FOI� •IT SE ONLY ) /� �t/� � � <br /> "�-���y City Of OronO Date Received: �7 Permit# L a� <br /> �1 P.O.Box 66 <br /> j`` � t 2750 Kelley Parkway ❑Tn-House SAC Determination Form Completed <br /> �, Crystal Bay,MN 55323 <br /> "'� . � (952)249-4600/Fax(952)249-4616 Approved By(if Required): <br /> . 4k'FS�� �. � - <br /> _ � - <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Buiiding Officiai and/or PvbEic Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoolication 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 pernut card is availabte on the job site. <br /> 5. Utility connection pemuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-buiIt locations. <br /> DO NOT E2►CAVATE IN ANY STREET AND DO NOT TAP ANY i11AIN without express <br /> approval of the Public Works Department. Issuance of a permit does not grant this approval. <br /> ?. All work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Cail(952)249-46U0,24+hour notice required. <br /> TYPE OF PERMIT <br /> Check All That A 1 <br /> �]Residentiai(May Require Approval) ❑Commercial(Approval Required) <br /> (�] New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑Disconnect <br /> � � ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site;Owner Information: <br /> Site Address: �n�sl ��-����s f-z'r�.� �r�,�� <br /> Ownez: ��h p�b Gt.0 �u��,Q t� �, Mailing Address: �� t� 7� i�l'CL'�►� � (,L•�1 Q,,, <br /> ci�y: z�p: 5 S 3 2 � <br /> Home Phone: Alternate Phone: �� � �r 7�� �.�j L(F, <br /> Contractor Information: <br /> � r. „ ' ,, � � '�1��,1��" <br /> Contractor: �� �l.l,l� ��tL Contact Person: � <br /> Address: � � LJ�� �.G�.G�'i��n�}'�11Q�State License#: <br /> City: l��L C��V�'v" Zip:S�3`l I Expiration Date: <br /> Phone: 7�=:� -'-}Z�—�'1 Dt�(7 Alternate Phone: �.�I Z �(�, iv�§�) <br />