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J , � <br /> . �J�. �� <br /> FO CI USE ONLY <br /> �,�` City of OCono Date Received:�� � Permit# 2�/7i�— ��� <br /> O4 `�`O P•O.Box 66 <br /> q 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �.� ��}"� 1�,�,''. � Crystal Bay,MN 55323 <br /> � '�'�'�a o 952 249-4600 A roved B If'Re uired <br /> '� ��fi�v�y ( ) PP Y( 9 )� <br /> t4$asaoa <br /> CITY OF ORONO-SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the ao�lication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits 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 permit 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 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 Apply) <br /> ,QResidential(May Require Approval) ❑ Commercial(Approval Required) <br /> �New Connection ❑ Additional Connection ❑Re-Connection ❑ Repairs ❑ Disconnect <br /> ' ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/ Owner Information: <br /> ,�- • < ' '' <br /> Site Address: � ���� �_�«��� ; �--�� � <br /> Owner: ,�7'�. �� TC y��Sc>�t f-l�t�S Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> � Contractor Information: <br /> Contractor: L�-`'����'�1�� S�c �:� Contact Person: �.��"��`` 1 �� �<��� �� <br /> � <br /> Address: - f�� �- �� State License #: <br /> City: ��LL��`��L Zip:S�j��`� Expiration Date: <br /> Phone: ���5�- � ��- L�l � l Alternate Phone: ��� ����- ���� � <br />