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Fou c�Tv�JSF o�v�v <br /> �� CILy Of�l'0110 Datc Received: Pcnnit# <br /> �� � '` P.O.Box 66 <br /> � <br /> �� � ' 2750 Kelley Parkway ❑In House SAC Detennination Porm Completed <br /> G� �N <br /> �t;� � �-!� Crystal Bay,MN 55323 <br /> �!� ''� � o`�' (952)249-4600 Approved By(If Rcquired): <br /> `:��:exoQ$ <br /> CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the[3uildine Ofticial and/or Public Works Depaitment*) <br /> (ALL P6:RMITS- A9av be subiect to further revicw and mav not be issucd when the aoolication is received) <br /> GENERAL INFORMATION <br /> l. 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 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]ocations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express <br /> approval of'the Public Works Department. (ssuance of a permit does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 8. All wark must be inspected before it is covered. Call (952)249-4600,24+hour notice required. <br /> TYPE OF PERMIT <br /> Check All That A 1 ) <br /> �Residential (May Require Approval) ❑ Commercial (Approval Required) <br /> ❑ New Connection ❑ Additional Connection �Re-Connection ❑ Repairs „�isconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> � �.J ���_�__ ��;1 <br /> Site Address: ,� `� �`� _._� � � � /� � �G%� <br /> -' C V� <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor�Information: <br /> �� <br /> Contractor: �,�L''�'t'S �i%'� I �����5���``��C:ontact Person: ( / �t � � `"� S ���> ��� <br /> —r— <br /> Address: ���e':� �_,p�✓l'y ,���Z'%�'�tate License #: <br /> City: �-� � Zip: �V Expiration Date: <br /> Phone: ��/;� � �G3��T L'��� Alternate Phone: <br />