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" - FOR CI Y USE ONLY <br /> i���0� City Of 01'ono Date Received: G Permit# �/ " ( 11 <br /> 1' . , P.O.Box 66 <br /> I � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> ,y� �-j Crystal Bay,MN 55323 �� <br /> `��,i,�A�.�{�¢��' (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> __.__� �r'� <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT `e <br /> (�'� <br /> (•Note:Some permits may require approval by the Building Official and/or Public Works Department') �� ibt� <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoolication is receivedl <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. <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 Department(952-249-4600)for utility stub as-built locations. <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 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 ply) <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: ���� �/lOW�✓ /�-4�, <br /> Owner: /V0,�1�� ��''�� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ��c�./Ll. ���-Q'i/�9'r'^'ri 1NL. Contact Person: � l�e <br /> Address: Z�l� �N7�/L�Qer6��� State License#: <br /> City: Rd��✓GS Zip:S�3 Expiration Date: <br /> Phone: ��J` ��6 "���� Alternate Phone: �/Z 9�9 ���1'�' <br />