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< <br /> , FO Y SE ONLY ��f /�2 �/� <br /> ,��,�` City Of OrOno Date Received: Permit# �%i��i/ i/ CJv/'— <br /> O A `rO P.O.Box 66 <br /> � 2750 Kelley Parkway ❑ In-House SAC Determination Porm Completed <br /> �'�'��' Crystal Bay,MN 55323 <br /> ���tj�;��.yG� (952)249-4600 Approved By(If Reyuired): �O� I(�1 <br /> raxos �!/(J <br /> CITY OF ORONO— SEWER& WATER/ GENERAL PERMIT <br /> (*iVote:Some permits may require approval by the Building OfYicial 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 /> GEN�RAL 1NFORMATION <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. Urility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locarions. <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 pernlit 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 /> �] 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 Water <br /> Job Site/ Owner Information: <br /> Site Address: l,5 � �I,(� C� <br /> Owner: U}��� � r�,� �-,,�e� Mailing Address: <br /> `_7'� <br /> City: Zip: <br /> �3f`�`�s rl <br /> Home Phone: Alternate Phone: 7�,,� -a6y - �6�r� <br /> Contractor Information: <br /> Contractor: Cr.���.� ,�� _ (�� u,t�l�� Contact Person: `�\ c��.f� <br /> Address: 4�y � ,r�:. nk..�� State License #: 5�7'3,-�ti� i�,�GL <br /> City: W�{P(�1rt�;,� Zip:� Expiration Date: t�a_,3�-1 <br /> Phone: qSa�-`I�`����1��� Alternate Phone: E1�--S�)S� �`fi�i 7`-� <br />