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� � <br /> F4R CITY USE ONLY <br /> O$��O Clty of 01'ono DateReceived: Permit# <br /> P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC I3etermination Form Corrg�leted <br /> ���fri,.� Crystal Bay,MN 55323 ` <br /> �_ ` '` (952)249-4600 Approwed By(If Required}: <br /> �q4�s� <br /> CITY OF ORONO-SEWER&WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department') <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued wheo 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 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 Inf�rmation: ' <br /> Site Address: 2j�Z S��v l,voo� ��� <br /> Owner: �-fic�e �oQ� Mailing Address: 2l7Z Sh�yu�000� ��� <br /> City: OQ o dJ o Zip: 55��^tL_ <br /> Home Phone: Alternate Phone: ��Z- l�6 S�- l Z S� <br /> Contractor Informarion: <br /> Contractor: �2cq LcJ,d P ���wi�1'� Contact Person: Q�i4 <br /> Address: �t'jB f /l�o �'� ST State License#: �� �J 3 7 � P�1 <br /> City: Sr�v�2 1a�c Zip:5�3�s Expiration Date: _1 Z-�1- 2olO <br /> Phone: QSZ-29'Z- 52 4 7 Alternate Phone: <br />