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� <br />� _� <br /> � ' <br /> FOR CITY USE ONLY <br /> 4�� Clty of OrOno Date Received: Permit# <br /> P.O.Box 66 <br /> ��;;.,�„ � 2750 Kelley Parkway ❑In-House SAC Determination Fonn Completed <br /> � y���,�'' �* Crystal Bay,MN 55323 <br /> �^�',i,���.�o (952)249-4600 Approved By(If Required): <br /> '�asxoa <br /> CITY OF ORONO— SEWER & WATER/ GENERAL PERMIT <br /> (*Note:Some pennits 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 aaolication is received) <br /> GENERAL 1NFORMATION <br /> 1. You may apply for utility peimits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Peimit cards will <br /> be sent by retuin 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 urility 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 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 Apply) <br /> �-Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> [�.New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑ Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: / � � <br /> Owner:����u��cl �crn�{, Mailing Address: <br /> `{`{�? ��-�-f� ��� I��P. <br /> City: ��c�"�P� t't4-12� Zip: ����� / <br /> Home Phone: _���—`��/" C�� Alternate Phone: <br /> Contractor Information: <br /> Contractor: ��, ��l��L'v Contact Person: <br /> Address: ��� �""'tO7�' � State License #: Lo� G� <br /> City: �i4�o t�€� Zip� Expiration Date: /LI�<� �a(�, <br /> Phone: �2�����• AlternatePhone: ��3-���?�c63 <br /> � <br /> � � <br /> � �� � <br /> � � � �: 1 n � ;�3 <br /> �k �k <br /> � <br /> � � � ` r <br /> �' � � � a'� i ..., . . � , �� � ��� � ,;:� . <br /> „ . . . . , . . , . . . . :�: � �" � i .� .?: <br />