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r � . <br /> TOR CITY USL ONLY �� _�`� <br /> � —� Ctty OT Ot'On0 Date Received: Permit 11 "�'' <br /> '� � �\�� P.O.Box 66 <br /> j �,,. �\; 27j0 Kelley Park��ay ❑In-House SAC DMermination Porm Completed ,�'L�� �Zr}��j7 <br /> y �i�'�� - �� Cryst�l Bay,MN�5323 <br /> '�'�d+��,� �}>au`f O��)249-4600 Approced I3y(If Required): � <br /> Eaxo�^> <br /> CITY OF ORONO—SCWE12 & WATE12/G�NEI2AL YERMIT <br /> (*Notc:Somc permits may require approv�l by the Buildin�OfPicill and/or Public Works Department*) <br /> (,�LI,PER`iITS- i�'lav be sublect to furlher re�•iew�nd m;rv not bc issuccl�nc�n the application is reccived) <br /> GCN�RAL INFORMA'l ION <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subjcct to the postage and handlin� fee shown belo���. Permit cards wil( <br /> be sent by return mail within 2 busincss days. <br /> 3. Pern�its nre not valid until you receive a permit c�rd. <br /> �4. Worl:must not be�ii� unless the permit card is available on the job site. <br /> �. Utility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Dcpartment(952-2�19-4600)for utility stub as-built locations. <br /> DO NOT E\CAVA1'E IN AN�'STRLET AND UO N01'TAP ANl' �'Ir1IN without express <br /> npprov�l of the Public�Vorlcs Department, Issuance of a per�nit does not grant this approval. <br /> 7. All work must be done in accordance with State Code requiremencs. <br /> 8. Ail worl: must�be inspected before it is covered. Call(952)?�9-4600,�4+ho«r notice required. <br /> TYPC OF PERMIT <br /> (Checic All That Apply) <br /> �Residential(May Require ApprovaO � Conunercial(Approval Re�uired) <br /> l <br /> �Ne�v Connection � Additional Connection�Re-Connection �� Repairs � Disconnect <br /> Job Site / Owner Informatioil: <br /> SiteAddress: �� � � W��V <br /> / <br /> � <br /> 1����ner: d ��� �1r'�� �Vlaiiina Adclress: <br /> City: lip: <br /> Home Phone: Alternate Phone: <br /> � Contractor Inforn�ation: �,�.�� <br /> p � ,(,� I � t � � <br /> Contractor: � [ � �{ ��� Contact Person: .�W 1 AN l� l� � �I �� � � <br /> _1 <br /> nddress: �`�.J�� �� �� � State Lice�lse #: <br /> City: ���vV�� V ��' 7ip:���1 Expiration Date: <br /> Phone: ��� v(��' -1 ��11/ Alternate Phone: <br /> i <br />