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Y <br /> l�r <br /> �- �', <br /> FU����.7` USE ONLY <br /> * ,���0� City Of OrOno Date Received: Per�nit# -� <br /> � 's P.O.Box 66 <br /> � 2750 Kelley Parkway ❑I�-House SAC Determination Form Completed <br /> �y� �-j Crystai Bay,MN 55323 <br /> \\��s`i�¢ti�� (952)249-4600/Fax(952)249-4616 Approved By(If Required): c�C� � Sj,� <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT � Z`�� <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Departrnent') <br /> (ALL PERMTfS- Mav be subiect to further review and mav not be issued when the anoticaHon is receivedl <br /> GENERAL INFORA�IATION <br /> 1. You may apply for urility permits by mail or in person at the City of�ices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pemut cards will <br /> be sent by rehun 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. Urility 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 A 1 <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: � 2' Z'� f�(r J e�c/ �v � <br /> Owner: Mailing Address: <br /> City: b v�a�` v Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor:�-��� � �a v a f. Contact Person: C �"' l / !.c� <br /> � `c`� �t <br /> �, ! � <br /> Address: ���S �oµK �y� State License#: �I3 CQ qS�Lo!�--f <br /> � � <br /> City: ���t K-cfh.'�f� Zip:3� 3'�Expiration Date: (Z--3��- �� <br /> Phone: ��Z '�Y-S'�S'',� Alternate Phone: <br />