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f , r <br /> - /�� F CI USE ONL � ���j <br /> -r�y�-�`y�, Cl�'Of OCOIIO Date Receivec���Pernut# <br /> �� � � � P.O.Box 66 <br /> ? �� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> ' ��� � , . Crystal Bay,MN 55323 <br /> ��� �� �''� �,:� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> CITY OF ORONO- SEWER& WATER/ GENERAL PERMIT �D�� <br /> (*Note:Some pertniu may require approval by the Building Official andlor Public Works Department*) <br /> (ALL PERMITS- Mav bc subiect to further review and mav not be issued when the application is received) <br /> GENERAL 1NFORMATION <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. Wark 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 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: � % =-'�� �-�`/ > �t7 ��-� <br /> �� ����,/ s ��;� <br /> Owner"f�-i S��J`� �./�, ���? < Mailing Address: <br /> City: Zip: <br /> Home Phone: r:, � � :C �5' ��7 � Alternate Phone: <br /> Contractor Information: <br /> Contractor: � -> ✓v���, `:� '7` !-%J Contact Person: �'�1�'Y' `7 <br /> Address: � 7 S ,1 � �'��� ��J State License#: <br /> City: �-'�'� �' G Zip;,�� Expiration Date: <br /> Phone: ��6 3 y 7,� � �/ � Alternate Phone: L.o! z -Z 5�� �' �5 S� <br />