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� �ou crTv t�sF o�vi,v <br /> . ��t��/��� City of OI'ono Date Received: Permit# <br /> P.O.F3ox 66 <br /> �� 2750 Kellcy Parkway ❑In-House SAC Detennination Form Completed <br /> r F Crystal Bay,MN 5�323 <br /> ",y��%�''� �u`;� (9�2)249-4600/Fax(9521 2�9-�361G Approved t3y(If Required): <br /> ;.��_ �;� <br /> CITY OF ORONO-SEWER & WATER/GENEKAL PERMIT ; �1� 15��'�� <br /> ( Note.Some p�rmits may rcquire approval by the Building Official and/or Public Works Department ) �� �� � ����( <br /> (AI.L PERMITS- Mav be subiect to f'urther review and mav not be issued when the apolication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City ofCces. <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 Deparnnent(952-249-4600)for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without espress <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: �� I� r �r �-��� � � i�v� <br /> Owner: ��3G�C�� �� c�`�'''— Mailing Address: ��� � �(�'G �f � <br /> , <br /> City: �✓1��=�- Zip: <br /> Home Phone: cI.SJZ '��'� �-�`�-3 Alternate Phone: <br /> Contractor Information: <br /> Contractor: <br /> ��al�i ���� Contact Person: i�u^ ��-"�— <br /> Address: � �l � C� --� �� � � �'� � � � <br /> � State License #: <br /> City: O���S Zip: `'���Expiration Date: � � -� 3 � � �� <br /> � <br /> Phone: I_.5������`���`�f Alternate Phone: CC L "��I�-��'� �� <br /> / <br />