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FOR CITY USE ONLY <br /> � Clty of Or'on0 Date Received: Permit# <br /> i'¢ � , P.O.Box 66 <br /> !��i. ��'' 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �� 11�'� �,�� Crystal Bay,MN 55323 <br /> �,�,r� i�i,�,i'� (952)249-4600 Approved By(If Required): <br /> ... �sxo8:.. <br /> CITY OF ORONO—SEWER & WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoplication 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 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 /> Job Site/Owner Information: <br /> Site Address: ���� ��W C� Ci��l� <br /> Owner: �.Q�f�l�� Mailing Address: <br /> City: O r� � Zip: <br /> Home Phone: �S� � + `�"� � �1`�� Alternate Phone: <br /> Contractor Information: <br /> Contractor: C011CfZ�Q. �G�n�-�.r Contact Person: Q�. ��� <br /> `15yS ornrnel'c�., <br /> Address: �.� I (,l�'_ State License #: <br /> ss34o �Z-3t - Zaoq <br /> City: Zip: Expiration Date: <br /> Phone: ��0.3 " �� ' �013 Alternate Phone: ��Z " ZOZ' �0�3� <br />