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. � a �, � <br /> � <br /> �,_..., ����o�.Y <br /> �����\ City Of OCono Date Received: �v Perm;c# 0�0/$-CJ 3.� <br /> � _ ; P.O.Box 66 <br /> � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �,y� �� Crystal Bay,MN 55323 <br /> \\��s�i�¢�f (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Departrnent•) <br /> (ALL PERMI'I'S- Mav be subiect to turt6er review and mav not be issued whon the anolication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for urility permits by mail or in person at the City of�ices. <br /> 2. Mailed in applicarions aze 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 cazd is available on the job site. <br /> 5. Urility 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 Wate <br /> Job Site/Owner information: <br /> Site Address: 2'Z�� ��SC-J �//?�/�' <br /> Owner: �� 5G� �/G/6I�/�S GL� Mailing Address: j�lvll�z l7���/ T <br /> City: �/y/1 G�A��i` Zip: S S`3�5` <br /> Home Phone: ��Z � �l'���7 Alternate Phone: �i�1'� -� <br /> Contractor Information: <br /> Contractor: ��f Contact Person: �pp������1/` � <br /> Address: �f�� �iv�l�.[ Gf���State License#: z ���Z� <br /> -7 , <br /> City: �///�� Zip: �`z Expiration Date: 7 <br /> Phone: �/� , /�—� 7d� Alternate Phone: �2'' �l y`���DG <br />