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. <br /> FOR CITY USE ONLY <br /> 40� City of OrOnO Date Received: Pennit# <br /> P.O.Box 66 <br /> ��7;;,,,, � 27�0 Kelley Parkway ❑in-House SAC Determination Form Completed <br /> a� ���'� ��;{ � Crystal Bay,MN 55323 <br /> ���,��r�w$o` (952)249-4600 Approved By(If Required): <br /> sexo$ <br /> CITY OF ORONO —SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Worhs DeparM�ent*) <br /> (ALL PERMITS- Mav be subiect to further revie��and mav not be issued when the�pnlication is received) <br /> GENERAL 1NFORMATION <br /> L You may apply for utility pernuts 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 pernut 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 locatioi�s. ' <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 peinut does not grant this approval. <br /> 7. All wark 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 Apply) <br /> ,�Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ( _ <br /> ❑ New Connection ❑Additional Connection ❑Re-Connection ❑ Repairs �Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: ���� �•'�`��'l //'� : <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> WL"J 4`1�nI/"� , � <br /> COI1tT'aCtOT: • � ��/C�s.'f � � <br /> 1� �c,✓ Contact Person: �� <br /> �'j�� CCi ,�� I� State License #: ��y��l <br /> Address: r 4 <br /> City: �/1/1�,�-✓�� Zip:���Expiration Date: ���� ��{'� <br /> �- <br /> Phone: C`��-�i��7�" `�l��o Alternate Phone: ���'z I 7`���!7 7`�� <br />