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FO CITY USE ONLY G <br /> O`��y Clty Of OiOnO Date Received:�_1a,P.e?mit#��� 7 � <br /> �l�� ��\� P.O.Box 66 <br /> � a�„t , �{ 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �� �;'�,r�" ��� �rys�al Bay,MN 55323 <br /> � A roved B If Re uired <br /> ��.4`,,/ 952 249-4600 PP Y� 4 )� <br /> �!+taxa� <br /> CITY OF ORONO-SEWER&WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Officia]and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the application 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 wili <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 Deparhnent(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: 1 ���) �� l�G�12 L� �� .f/��' L�� <br /> Owner: (_�!�� N�� F51-l�C'� Mailing Address: 5���J (��1 �l `��� V�'L-- � • <br /> City: ��l �A_l/U 1=1�4�.)�LiL.� Zip: .5��t�i <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ��.�t lZ/Ll� Clr�lW�1� Contact Person: S�-�(�, �LZ(�/l.��- <br /> Address: �'J`�7� ��(.7 �ZC( z 1 State License#: �I��L lq�i ���7 <br /> 5�3��U <br /> City: �� LIZ Zip: Expiration Date: <br /> Phone: ��'I S z� C S� -�!/Z. Alternate Phone: ��O�z� ��� �/,3CJ� <br />