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L <br /> _ . FOR CITY USE ONLY <br /> . 4�� Clty of Ol'on0 Date Received: Permit# <br /> P.O.Box 66 <br /> ��;.� � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> a �>> ��,' � Crystal Bay,MN 55323 <br /> ��^t ri���M�.$a` (952)249-4600 Approved By(If Required): <br /> '��axo$ <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 when the aaDlication 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 pemut 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]ocations. <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 pernut 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 Ap ly) <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> �New Connection ❑ Additional Connection ❑ Re-Coruiection ❑Repairs ❑Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: �'/' 5�-�-►v�-�`� �'L°'�" <br /> / C�' , <br /> Owner: aC/..-C�-�-�- �''���'�� Mailing Address: <br /> City: �.%L�Z�-- Zip: <br /> Home Phone: ��G� 7 3 �F y� Z Alternate Phone: ,�i �� 7„�j � �J�✓�� <br /> Contractor Information: <br /> 9 �j r C' <br /> Contractor: /%.G�,,,,_d��,���DG- Contact Person: ,�i��- i��. <br /> Address: �l � d �.�-/�z' State License #: � � �� ` <br /> � <br /> City: � Zip: ��3T�xpiration Date: � � ` <br /> Phone: ��� " ���1- /��L- � Alternate Phone: � `� ��`� "l�� �- <br /> t '� <br /> � ti <br /> �, � �: s � � � <br /> } � ; <br /> , �� � <br /> � <br /> �, � <br /> ,` �; ' ; �,. <br /> .� . � F . . :�i e � v ,��4� + . . � A,_ � .. . ?� �..5 1�.: .�� .� t�.' .. � k.: . <br />