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t <br /> , <br /> FOR CITY USE ONLY <br /> ' � �'�`, �` Cl�'Of�TOIIO Date Received: Permit tk _ <br /> .,,r.` <br /> P.O.Box 66 <br /> �, � 2750 Kelley Pazkway ❑In-House SAC Detertnination Form Completed <br /> ' `�b � Crystal Bay,MN 55323 <br /> `: � ' (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Oft'icial and/or Public Works Depar[ment*) <br /> (ALL PERMl'I'S- Mav be subiect to furt6er review and mav oot be issued when the anulication is received) <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 ezpress <br /> approval of the PubGc 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+hoar no6ce required. <br /> TYPE OF PERMIT <br /> Check All That A 1 <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: �`1�U ���t�e.� ���' <br /> Owner: ��� ,Sc�'n�,5 Mailing Address: <br /> City: (�r�,�c�, Zip: �`�3J Cs2 <br /> Home Phone: Alternate Phone: <br /> Contractor Information: � <br /> l V��S ! L - <br /> Contractor: (�1nr,c�l;e, 1 ,c,�es�`naN,�e.r Contact son: Ghcr�+� �,J'i�1nc�3e-� <br /> Address: State License#: -�MO(ot1(Day <br /> City: (��5�,�--�ip: Expiration Date: a l� <br /> � <br /> Phone: Alternate Phone: <br />