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t � <br /> FOR CITY USE ONLY <br /> ��� City of Ot'ono DateReceived: _ Per!nit# <br /> P.O.Box 66 <br /> �y�,; � 2750 Kelley Parhway ❑In-House SAC Determination Form Completed <br /> a �f����� �* Crystal Bay,MN 55323 <br /> �`�t��'ch!W'w°~ (952)249-4600 Approved By(If Required): <br /> '�saxo$ <br /> CITY OF ORONO — S�WER& WATER/ GENERAL PERMIT <br /> (*Notc:Some permits may require approval by the Building Ofticial and/or Public Works Department*) <br /> (AI L PERMITS- h'fav be subicct to further review and mav not be issued when thc aonlication is reccived) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pennits by mail or in person at the City offices. <br /> 2. Mailed in applicarions are subject to the postage and handling fee sho�m below. Pernut cards will <br /> be sent by rehi�zi mail within 2 busuless days. <br /> 3. Permits are not valid until you receive a pernrit card. <br /> 4. Work must not begin unless the peinut card is available on the job site. <br /> 5. Utility coimection permits may be issued to licensed conh�actors oi�ly. <br /> 6. Contact the Public Works Department(952-249-4600) for utility shib as-built locations. <br /> DO NOT EXCAVATE Il�ANY STREET AND DO NOT TAP ANY MAIN without express <br /> approvai 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 /> S. All work inust be inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> TYPE OF PERMIT <br /> (Check All That Apply) <br /> �Residential(May Require Approval) ❑ Conmiercial(Approval Required) <br /> �-New Connection ❑Additional Coimection ❑Re-Connection ❑ Repairs ❑Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: ���(.i ���d� ���c> �� . <br /> Owner: t'c��, � ���-����S �'���K�'S Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: � �S��`� ✓� S`� Contact Person: (��`��•� �. (�f�I <br /> Address: �' / ��-_J �S State License #: � S�� `�'T��~7 <br /> City: ����`�` Zip'S�j�`� Expiratioi�Date: l� � S�"��`'� <br /> Phone: �, �j� l `t7� -Y��b Alternate Phone: � ����� 7��'� �� � <br />