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F�33F.ONLY <br /> �����i Clty Of�1'OItO Date Received: � Permit# C� `� C' 7�-� <br /> � P.O.Box 66 <br /> �1 2750 Kelley Parkway ❑In-I�ouse SAC Determination Fortn Completed <br /> , � , � Crystal Bay,MN 55323 „ <br /> ``�'�, � � (952)249-4600/Fax(952)249-4616 Approved B (lf R uired : r* <br /> r <br /> . T,,�tf�>�> Y �t ) —� ���� �,����`b/ <br /> CITY OF ORONO— SEWER& WATER/GENERAL PERMIT ��,L�`� .�L1��`� <br /> (*Note:Some permits may require approva]by the Building Ot�cial and/or Public Works Department*) ��.�,r/ <br /> (AI,L PF,RMITS- Mav be subiect to further review and mav not be issued when the aoolication 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 Depart�nent(952-249-4600)for utility stub as-built locations. <br /> DO NOT EXCAVATE 1N 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 befare it is covered. Call(952)249-4600,24+hour notice 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: �y9d �'9�tAn/ S7; <br /> Owner: �i✓�k2�'� ,8�02�5 Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ��5,/11,�'_:l.'�V��✓L ��v�. Contact Person: : ��a 9�9 y3��3 <br /> Address: r�91� ��'rt�.�,i� �� State License #: <br /> City: ��✓GS Zip: �5'�D3J' Expiration Date: <br /> Phone: 1e�'/� �i'�'fD - /�3s'S-� Alternate Phone: �/� g/9 �/3y� <br />