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FOR CITY USE ONLY <br /> �, ,¢�� Clty Of OCOno Date Received: Permit# <br /> P.O.Box 66 �C)� <br /> �' �,'` � 2750 Kellcy Parkway ❑In-House SAC Determination Form Completed �, �J '�� <br /> k•R�.'.�tfY <br /> `i ? <br /> a �j�•ch,ar�-. � Crystal Bay,MN 55323 � � � �� <br /> ��t��r�i,��"�°� (952)249-4600 Approved By(If Required): �L <br /> �Raexoa <br /> CITY OF ORONO —SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval Uy the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the apnlication is received) <br /> GENERAL INFORMATION � <br /> 1. You may apply for utility peimits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Peimit 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 comiection permits 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 ANY STREET AND DO NOT TAP ANY MAIN without express <br /> approval of the Public Works Department. Issuance of a pern�it 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 O�' PERMIT <br /> (Check All That Apply) <br /> ❑ Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> � New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: � � 5�5 � �� d"����� �'� � /!J <br /> Owner: � ���;� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> � � <br /> ,�/��; --� �/ � <br /> Contractor: � ���►D�I S 2�C-c-� Contact Person: � ��� %�- ��� <br /> �� <br /> Address: 7� s �CC`�������� State License #: 5��� <br /> Cit � <br /> y: ����f�-�-� ,��/2)Zip c3-� L�xpiration Date: � � 3� L� C� <br /> Phone:�( j y7r� � %/� Alternate Phone: 4�' 1,.L �/f> L7 � y '> <br />