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FOR 'ITY U E ONLY � ��'� <br /> � City Of�l'Ono Date Received:� � �7'�rniit# G�i" U���� <br /> O� '�O P.O.Box 66 <br /> �,;, 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> ,a �� �� a Crystal Bay,MN 55323 <br /> �������o� (952)249-4600 Approved By(V Required): <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 anplication 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 pernut 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 MAIN without express <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 /> 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 /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site / Owner Information: <br /> Site Address: J��� �l�`� �� ��`' � <br /> Owner: I.�:���.��� �� � ���`� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> � / /� ;� ; r <br /> Contractor: ���S�a� k S S/� Contact Person: ! �(/'�G� � �'�� �'1 <br /> Address: �"J�U� C� ���• �� State License#: �u�/��"� <br /> City: �t'`'"�� Zip:.�����Expiration Date: �2- ��- �I <br /> Phone: -1.�-Z- � 7�' �`7� Alternate Phone: b ��-7��-� �� j <br />