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f <br /> , ~ , i5 (� � <br /> > <br /> �r.. FOR CITY USE ONLY <br /> ;�'� ���`: <br /> �;��-- y� � Cl�Of�COriO Date Received: Permit# <br /> �`` ' P.O.Box 66 <br /> `i ' 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> t 1\� k <br /> � Crystal Bay,MN 55323 <br /> �� ✓�`�, �� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> ��''' <br /> CITY OF ORONO— SEWER& WATER/ GENERAL PERMIT <br /> (*hote:So�ne pennits�nay require approval by the Buildine Official and/or Public Works Depamnent*) <br /> (ALL PERMITS- Mav be subiect to further revieN and ma�not be issued when the appGcation 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 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(952-249-4600)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 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. Call(952)249-4600,24+hour 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 „�Repairs ❑ Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: � /(Q,�J S���C�Z�1 �L��� <br /> Owner: �,1�r7�'( vG���"�' Mailing Address: /11(l� �`J/�� <br /> City: �l�C�'l�� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: -7r�����l�� �'�'�%� Contact Person: ���1� -%C�/�C��— <br /> Address: �+�7����� �/�'�`� State License#: �[�7.���� <br /> City: �������/��� Zip:��'� Expiration Date: � Z 5 � �� <br /> 7�,-�/ c� � <br /> Phone: 7��. !��6 `�<�✓ Alternate Phone: <br />