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FOR CITY USE ONLY <br /> ��0�� City orUl'On0 Date Rcceived: Permit# <br /> Q ���� P.O.Box 6fi <br /> ,•: 2750 Kelley Parkway ❑In-House SAC Determination Fonn Completed <br /> t+;'. � �� Crystal Qay,MN 55323 <br /> ���� �-�r }�o,-.�� (952)249-4600 Approved E3y(If Required): <br /> �xaaso°.- <br /> CITY OF ORONO—SEWER & WATER/ CENERAL PERMIT <br /> (*Note:Some permits may rcquire approval by thc 13uilding Ofticial and/or Public Works Department*) <br /> (ALL PER�11"f S- �la��be subiect to fw-iher revie�r and ma��not be issued�rhen the application is receivecl) <br /> GENERAL INFORMATION <br /> 1. You may apply fu;-utility pern�it5 by mail or in person ut the City oftices. <br /> 2. Mailcd in ap��lications are subject to thc posta�e and handling fee shown below. Permit cards will <br /> be sent by returi� mail within 2 business days. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless thc permit card is available on thejob site. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> 6. C�ontact the Public Works Department(952-249-4600)for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREE'('AND DO NOT TAP ANY MAIN���ithout ezpress <br /> approval of the Public Works Department. Issuancc 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 beforc it is covered. Call (952)249-4600,24+hoin•notice required. <br /> TYPE OF PERMIT <br /> (Check All That A 1 ) <br /> ❑ Residential (May Re�uire Approval) ❑Commcrcial (Approval Required) <br /> ❑ New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs �Disconnect <br /> ❑ Water Availability Connection For Futw•e Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: ��� "�J �S�-U ��� C�-A���� 1���a� <br /> Owner�h�������1�(>C� Mailing Address: ��- C����j �C:��C ���i� �- <br /> ciry: `NC'�'�`Z-�-°�-- zip: `�5��1 � <br /> Home Phone: �(1 �� Alternate Phone: n�� <br /> Contractor Information: <br /> Contractor: �-�Y�`U,� �1�Cl�� Il��i Coi�tact Person: � ��Yl l�' ������ <br /> Address: 3��1 ���U�t ��r1�' State Liceiise#: <br /> i <br /> City: ��� Zip:�3� Expiratiou Date: <br /> Phone: ��� ������l U� Altei7�ate Pho�7e: �D�� �J���"o��� l <br />