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r �" <br /> . � <br /> FOR C1TY USE O1�TLY //,/� <br /> 4Z«N� City o[O�wno Date Received: Pemirt d1 " 7r <br /> A.O.Box 66 <br /> � 3750 Kelley Park�tiay ❑In-House SAC Determwahon Form Completed <br /> r ,� Crystal Bay.�dN 55323 <br /> .'�� �,.��`N (952)249-4600;Faa(952)349-4616 Approved By(I£Required): <br /> F1,�„�h <br /> CITY OF ORONU—SEWER& WATER/GENERAL PERMIT <br /> ('Note:Some permits may require appro�•al by the Buildung O�aal andlor Publu Warks Depa�Ymrnt') <br /> (ALL PERMITS- �Zav be snbiect M fnrt6er reciew aud mas•aot bo isxuad tv6ea the aoolicatioa is recair-ed) <br /> GENERAL INFORMATION <br /> ' 1. You may t�pply for utility pemuts by inail or in person at the City affices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will <br /> be sent by rehim mail within 2 business days. <br /> 3. Permits are not vAlld until yon receive a permit card. <br /> 4. Work mt�st not begin wiless the perinit ctud is avail�►ble on the job site. <br /> S. Utility conttection peimits 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 Al�'Y STREET AND DO NOT TAP Al\�MAIN without eapress <br /> Approvat of the Pabtfc Works DepArtmeut. Issuance of a permit does not grant this appro�•al. <br /> 7. All work m«st be done in accordance witli Staie Code requirements. <br /> $. All work must be inspected before it is covered. Call(952)249-4600,24+hoar notice��equii�ed. <br /> TYPE OF PERMIT <br /> Check All That A 1 <br /> �Residential(May Require Approval) ❑Commercial(Approval Recluired) <br /> (�New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water AvailaUility Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: '��1 S�1�n[�,t4�-bN-�. �1((�..�,C� <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: � Q►� Cantact Person: 11�, �(�C6VY� <br /> V1�1Q5bn� 1 ►�G <br /> Address: Q)b0 �,�t w,D�tRr �1'�� State Licanse#: <br /> City: _ Zip:�q Expiration Date: <br /> Phone: �(03 -�13-6�1� Alternate Phone: L12--bg�-'�g� <br />