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FOR C1TY USE ONLY <br /> � City of OrOno Date Received: Permit# <br /> O4 '�� P.O.Box 66 <br /> �,,;:,,, 27�0 Kelley Parkway ❑in-House SAC Determination Form Completed <br /> a� ���`y'?A;z;-� �+• Ciystal Bay,MN 55323 <br /> � 'Tt� �'s�..o"' (9�2)249-4600 Approved By(If Required): <br /> ��� � <br /> �ssso� <br /> CITY OF ORONO-SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some pennits may require approval by the Building Offlcial and/or Public Works Department*) <br /> (.4LL PER1�11TS- iltav be subiect to further review and mav not be issued when tlte annlication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pernuts by mail or in person at the City offices. <br /> 2. Mailed in applications are subjeet to the postage and handliizg fee shown below. Pernut cards will <br /> be sent by return mail within 2 business 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 connection permits may be issued to licensed conh-actors 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 pennit 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 Coimection �Re-Connection ❑ Repairs ❑ Disconneet <br /> Job Site/ Owner Information: <br /> Site Address: ����� /�vhr✓-3 G�� ,/r�` <br /> Owner: ,��� `17�/��S Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: �/�es�o-� ���C���c- Contact Person: ����` /`��� <br /> Address: ll/3,S State License #: �-- '�/D yiZ <br /> City: !�'I/� /�� �k'�'�' Zip:;S��Expiration Date: <br /> Phone: �'�a-5'yG �-�,��( Alternate Phone: �lrZ ,3�� ��1� ��l <br />