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�( o�ep� <br /> FOR CITY USE ONLY <br /> ��� City of OCOnO Date Received: 1�Permit# <br /> O t Q P•O.Box 66 <br /> �^ �,,, 27�0 Kelley Parkway ❑In-House'SAC Determination Form Completed <br /> ��'���r;�'_ �. Crystal Bay,MN 55323 <br /> �� ��-}��r��,{c.�o` (952)2a9-4600 Approved By(If Required): <br /> ��ssoa <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 1nn��cation is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pernuts by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will <br /> be sent by retuin mail within 2 business days. <br /> 3. Permits are not valid until you receive a pernut 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 contractars only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locatious. <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 pemut 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 /> , <br /> �Residential(May Require Approval) ❑ Conunercial(Approval Required) <br /> [�'New Coiuiection ❑Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: �.5� � ,��2�'yL ��- �• <br /> Owner:�il,Pvr,, 4'C/Lts��l MailingAddress: �S- -5 !�'�`k�?i ��-v� <br /> City,�1� / ' Zip: .� � �c���� ' <br /> / <br /> Home Phone: 7;a- �7�/�� Altenlate Phone: <br /> Contractor Information: <br /> J - <br /> Contractor: �� �� Contact Person: � <br /> � ��, <br /> Address: ,�-�� ��� ' �S��v State License #: l°� � <br /> City: ��'l?i1������ Zip: �,���xpiration Date: _ <br /> Phone: ���- �f�� �Cf� � Alternate Phone: ���� �-�'�� - �5���� /,�" <br />