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� � ���0�� City Of OrOIIo Date Rece�o������-�� �' ! ��J�� <br /> ; P.O.Box 66 <br /> j 2750 Kelley Parkway �In-I�oese SAC Determination Form Completed <br /> l�� ,�-� Crystai Bay,MN 55323 <br /> � (952)249-4600/Fax(952)249-4616 Approved By(If Rtquired); <br /> \�titSH�Q'� . - . - . . <br /> CITY OF ORONO-SEWER&WATER/GENERAL PERMIT <br /> (*Note:Some pe�mits may require approval by the Building Official and/or Public Works Departrnent') <br /> tA.�.L PERMITS- Mav be subiect to turther revitw and mav not be�ssoed when We ao�li�K��+c rr�.,p���� <br /> GENF,�tAi,INFORMATiOI� <br /> 1. You may apply for utility permits by maii or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Peimit cazds will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are not valid until yon 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 MA.IN without egpress <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 /> TYP�OF PER�IT <br /> Ch�ck All That A i <br /> fl 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 /> Jo� Si�te/Ov�er Ir�or�ation: <br /> Site Address: . ✓� �� � � /'/ � <br /> Owner;����?t/�-�Z 1`1�2r✓ Mailing Address: l��� l.. / ���.��{' ,f� <br /> City: Zip: � ����.r <br /> Home Phone: �/�2- ,�?Z�/��� Alternate Phone: ���2�0--�'��'� <br /> Contractvr Information: <br /> (� . <br /> Contractor: -.) . ����,�� �, Contact Person: � ^el�' <br /> Address: y,71� /3���iv�� .jo. State License#: <br /> Ciiy: /�� Zip;��T'V�Expiration Date: �� ,3�' /� <br /> Phone: ���_��(J �-� Alternate Phone: Col�- ��,�- ����-�" <br />