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\ «` <br /> � l <br /> FOR C[TY USE ONLY <br /> 4�� City of 01'ono Date Received: Permit# <br /> P.O.Box 66 <br /> �� � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> a ���rC � Crystal Bay,MN 55323 <br /> �'� ��� ��b o~ (952)249-46�0 Approved By(If Required): <br /> t'�'Ps�fa$ti <br /> CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some pem�its may require approval by the Building Ofticial and/or Public Works Department*) <br /> (AI L PERMITS- MaV be sublect to further review and may not be issued when the annlication is received) <br /> GENERAL INFORMATION <br /> L You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applicarions are subject to the postage and handling fee shown bzlow. Pern7it cards will <br /> be sent by rehu�n 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 pernut card is available on the job site. <br /> 5. Utility coiuiection permits may be issued to licensed conh�actors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility shib as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express <br /> approval of tlie Public VVorks Department. Issuance of a pernut 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 APPIY) <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: -� 5 �� r`�•� � Lv c� c�<��1 �V �.. <br /> Owner: �� �ri: nC ��c;t� � .'J z'(,l�, Maiiing Address: <br /> rf <br /> City: Zip: <br /> Home Phone: �"I � I � S� � Altemate Phone: <br /> Contractor Information: <br /> Contractar: rv'J�-:���7�_ C�c1�_ �i� G �"� �,'/��/�G�'.�/'��- <br /> �%id.r/ Contact Person: �y �/�9 <br /> Address: ,�y�� �� !�� State License#: <br /> � <br /> City: ����0"�'�f'� ZipS,S��-�Expiration Date: <br /> Phone: �� "��-s ���� Alternate Phone: C�`�'��J��d� � <br />