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� <br /> , <br /> FOR CITY USE ONLY <br /> ���` City of OI'ono Date Receivedi Permit# <br /> "r P.O.Box 6G <br /> ��; � 2750 Kelley Parkway ❑ in-House SAC Determination Form Completed <br /> a '����.'.� �. Crystal Bay,MN 55323 <br /> �� �;' � r� o` 952 249-4600 Approved By(If Required): <br /> t�1�w���� ( ) <br /> CITY OF ORONO —S�WER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or PuUlic Works Department*) <br /> (ALL PERIIIITS- Nlav be subieM to further revicw and mav not be issued when thc anniication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pennits by mail or in person at the City offices. <br /> 2. Mailed in applicarions are subject to the postage and handling fee shown below. Pernut cards will <br /> be sent by rehn-n mail within 2 busuiess days. <br /> 3. Pei-mits are not valid until you receive a pernrit card. <br /> 4. Work must not begin unless the pernut card is available on the job site. <br /> 5. Utility coiulection permits may be issued to licensed conri�actors oi�ly. <br /> 6. Contact the Public Works Department(952-249-4600) for utility shib as-built locations. <br /> DO NOT EXCAVATE I'ANY STI2EET AND DO NOT TAP ANY MAIN�i�ithout express <br /> approval of the Public VVorks Department. Issuance of a pernut does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> S. All work inust 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 Connecrion ❑Re-Connection ❑ Repairs ❑Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: ` D � C- C�' <br /> Owner: ��� Mailing Address: <br /> City: Zip: <br /> Hoine Phone: Altemate Phone: <br /> Contractor Information: <br /> � <br /> Contractor:��v�L �7 � w Contact Person: � � <br /> Address: � �5 /U����� State License #: �� �Z <br /> City: 4�����—(' Zip:S�C�xpira+.;o„ Date: I v� .� � � � <br /> Phone: 7�� `�� � � �l� Alternate Phone: (� � � ��� �� `7 � <br />