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. � - . <br /> FOR CITY USE ONLY <br /> �0�` Clty Of 02'on0 Date Received`. Permit# <br /> "r P.O.Bo�66 <br /> ��;, � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> � 1����',L � Crystal Bay,MN 55323 <br /> � �7� ,{o o~ (952)249-4600 Approved By(If Required): <br /> t t�l�';$�, <br /> '�sacca <br /> CITY OF ORONO—S�VVER& WATER/ GENERAL PERMIT <br /> (*Notc:Some permits may require approval by the Building Ofticial and/or Public Works Department*) <br /> (ALL PERI191TS Mav be subiect to further review and mav not be issuecl when the apnlication is received) <br /> GENERAL]NFORMATION <br /> 1. You may apply for utility pennits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will <br /> be sent by rehml mail within 2 busuiess days. <br /> 3. Permits are not valid until you receive a pernut card. <br /> 4. Work must not begin unless the pernut card is available on the job site. <br /> 5. Utility coiuiection permits may be issued to licensed conhactors oi�ly. <br /> 6. Contact the Public Works Department(952-249-4600) for utility shtb as-built locarions. <br /> DO NOT EXCAVATE Il�ANY STREET AND DO NOT TAP ANY MAIN w�ithout express <br /> approval of the Public'1�'orks Department. Issuance of a pemut does not grant this approval. <br /> 7. All work must be done in accordance with State Code requuements. <br /> S. 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 APP1Y) <br /> �esidential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Coimection ❑Additional Comlection ❑Re-Connection ❑ Repairs [�Disconnect <br /> Job Site/ Owner I�Zformation: <br /> Site Address: 1 Lj�C� �G��f J'�� ���� <br /> Owiier: ���%' �� � ���z�e��� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: (,c�`�������� �l� �/(,� ContactPerson: l,54'� `�°'� Cl� �`� <br /> z <br /> Address: ����� �� • �c�` �� State License#: � �s�`�/"�� <br /> City: vZ�E�-�-���c� Zip: +�rr�. Expiratio»Date: j�.��_ �� <br /> Phone: ( �o� I � 7v� � ��`� `� Alternate Phone: ���2 � l-7 �7S <br /> � <br />