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rolz ci1�t us�.o�Lv <br /> � City Of Ot'OI10 Date Rcceived: Permit# <br /> ��� `` P.O.Bos 66 <br /> � �� �'� 27�0 Kelley Plrkway � p <br /> ❑In-Elouse SAC Determintltion Fo i Com fetcd <br /> �,.� '��� ��� Crystal a�y,MN��323 <br /> �a���;,�,�o��o`;� (9�2)2�t9-d600 Approved By(If Required): � " � �2 <br /> CITY OF ORONO—SGWER & WATEK/ GEN�I2AL PERMIT <br /> (*Notc:Soinc pcnnits may requirc approval by dic Buildin�Official and/or Public�h�orks Departmcnt*) <br /> (ALL PI:R��ITS- �ia��bc subicct tu furthcr rc��icw and mav not bc issucd whcn thc applicafion is reccived) <br /> GEN�RAL 1NFORMA'I,ION <br /> 1. You inay apply for utility pe�rmits by mail or in person at the City offices. <br /> � ?. Mailed in applicatioi�s are subject Co the postage and 1landling fee sho�-vn below. Permit�cards will <br /> be sent by return mail �vithin 2 business days. <br />� 3. Permits arc not valid unfil�rou receive a permit c�rd. <br /> �l. Worlc must not be��in unless the permit card is available on ihe job site. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> � 6. Contact the P�iblic Works Department(95?-249-4600)for utility stub as-built locations. <br /> DO NO"C F.�CAVA"CE IN Ah'1'STRGET F1ND DO NOT TAP AN1' iVIt11N H�ithout express <br /> �pproval of the Public Worl:s Department Issuance of a permit does not grant this approval. <br /> 7. All work must bc done in accordance���ith State Code rec�uirements. <br /> 8. All worl:must be ins�ecCed before it is coveced. Call (952)2�19-4600,24+hour notice required. <br /> TYPC OF PERNIIT <br /> � (Checl< All That A ply) <br /> �Residential (May Require Approval) � Commercial (Approvai Reqtiired) <br /> �New Connection �' Additional Connection �Re-Connection �❑J Repairs � Disconnect <br /> Job Site /Owner Information: <br /> Sitc Address: �bb �1�6V1,� 1�1 -KC�� NG rf(/1 <br /> Uwiler: �"eYIC� I� IVlaiii�l� Ac1c(ress: -`�-�'�'l e <br /> c�ty: ��'a�� z��: 5535� <br /> I-(ome 1'hone: _C]�j �"7���C� Alternate f'hone: � �O�Z �J'T—�"��� <br /> � <br /> Contractor Information: � ��Z� �3�0- �Z S7 <br /> Contractor: �'�U��'1 ��( �'v�.Q✓ Contact Person: I�VV�-f �►�U� <br /> � <br /> Address: � �eJ �(�7�e 1� �1�' State L icense #: <br /> City: _��iirl'�i "Lip:�'J�vExpii•ation Date: <br /> Pllone: ���3 ¢7�"���Z Alternate P11one: <br />