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<- <br /> i <br /> t <br /> ;.: FOR CITY USG ONLY���7v �D O/�� <br /> .. <br /> /:����1�1�-.,�� Cit3'Of 01'Orio Date Received: Permit# <br /> � '� P.O.Box 66 <br /> ? � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> ' � ; Crystal Bay,MN 55323 <br /> i } <br /> 'o'��_�"� � ��J (952)249-4600/Fax(952)249-4616 Approved By(If Reqwred): <br /> �` � <br /> CITY OF ORONO— SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official andlor Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further revieN�and ma��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 of6ces. <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 oot valid until vou 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]icensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility sCub 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 /> r <br /> _ ' � <br /> 'd ntial(May Require Approval) ❑ Commercial (Approval Required) <br /> ew 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: �Z� ���G,�c�-�. - <br /> Owner:Ie�dn/�� ���..�-. Mailing Address: <br /> City: I�Srv-r� IM�� � Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ���y`.'C,�,�n . 1-F•C Contact Person: , S , <br /> Address: 1�3 L�e 5��-+�.'� � . State License#: �C-S��3� ` <br /> City: Cr1 k�,A�� Zip: ��N Expiration Date: <br /> Phone: Q�2 25d �+� Alternate Phone: �' <br />