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�. <br /> . � <br /> t � <br /> _m�.��-FOR CITY USE ONLY <br /> ��Z��/V�, City�of Ot'Ooo Date Received Permit# <br /> P.O Box 66 <br /> \� 2750 Kelley Pulnti-ay ❑In-House SAC Detemiwat�on Form Completed <br /> �� � Crystal Bay,vfN 553?3 <br /> ; -:j''�, ��-' (9�?)249-4600 r Fax(95')?a9-4616 Approced By(IfRequired): <br /> ,,, <br /> CITY OF ORONO-SEWER & WATER/GENERAL PERMIT <br /> ("Note:Some permits inay requ�re appro�•al by tl�e Bwidan$Offieial and`or PubGc Works Department*) <br /> (ALL PERbIITS- llav be subiect to further reciew and ma��not be issued w6en the aapliration ix receiced) <br /> GENER.AL INFORMATION <br /> ' 1. You may apply for utility perniits by inail or in person at the City offices. <br /> Z. Mailed in applications are subject to tlie postage and l�andluig fee shown betow. Pennit cards��ill <br /> be sent by rehirn mail w�ithin 2 business days. <br /> 3. Permits ace uot��alid until you receive a permit cArd. <br /> 4. Work must not begui unless the permit card is acailable on the jab site. <br /> S. Utility coiuiection pennits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Departnzent(952-249-4600)for utility shib as-built locations. <br /> DO 1VOT EXCAVATE IN A1�Y STREET A�TD DO?\'OT TAP A1�Y MAIiV'�r•ithout expi•ess <br /> appro��Al of the Public Works Depai�tment. Issuance of a permit does not grant dtis approval. <br /> 7. All work miist be done in accordance witl�State Code requirements. <br /> 8. All��ork must be uispected before it is covered. Call(952)249-4600,24+houc notice required. <br /> TYPE OF PERMIT <br /> Check All That A 1 <br /> (�Residential(May Require Approval} ❑ Commercial(Approval Required) <br /> [�Nev��Caiuiection ❑Additional Coiuiection ❑Re-Coimection ❑Repau•s ❑Discoimect <br /> ❑ Water A�-ailability Corwection For Future Hook-Up to Water <br /> Job Site/Owuer Inforivation: <br /> Site Address: oZl.�� ��-S�Ci �..QYISZ� <br /> Owner:c5�6YlQ. �a pj ,�1��.�Q� Mailing Address: <br /> CitY: Zip: <br /> Home Phoue: Alternate Phone: <br /> Contractor Iuformation: <br /> Contractor: Ta.�h Y 04 C C�ntact Person: �l�K -Jrt.(�,r6YYl� <br /> In�QSon ry� <br /> Address: �'j lC0 �ot.(,�i�'YtCnQ..5t /��. State License#: <br /> City: �YLX. Zip:��cJ Expu•ation Date: <br /> Phoue: �b�v-�f_�-6�1$$ Alteinate Phone_ (o)a �-�g5-��7 <br />