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FOR CITY USE ONLY <br /> 40� CItV of�COnO Date Received: Permit# <br /> O r. O P•O.Box 66 <br /> �,;.;,,, 27�0 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �j�����r�;' � Ciystal Bay,MN 55323 <br /> �d� '�,(��';�la o'` (952)2a9-4600 Approved By(If Required): <br /> t'�eii a� <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 fw•ther review and mav not be issued when thc annlication 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 return mail within 2 business days. <br /> 3. Pernuts are not valid until you receive a pernut card. <br /> 4. Work must not begin unless the peinut card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed conn•actars only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locatious. <br /> DO NOT EXCAVATE IN ANY STREET Al\'D 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 Apply) <br /> ❑ Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> � New Conneetion ❑Additional Coimection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: �� �r�)c.t> I'1 �d � � , <br /> Owner: �C�� -t'O�a;CB.�S� Mailing Address: ��� �rocc�n�i.,�� <br /> City: �(�C3 Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: � /� �`r `�v Contact Person: � ( / <br /> Address: �� � I � � ���--,� State License #: I 2. � <br /> / � 5��0 � � ' � 1 �- a S <br /> City: ��J�1���-�--� Zip: Expiration Date: <br /> Phone: �J � � 9'1 C/ � �-y� Alternate Phone: <br />