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FO �TY USE ONLY 7 <br /> ���^/O Clty of OroIIo Date Received: t�er►nit# L �� � �� 'C� � <br /> P.O.Box 66 <br /> �1 2750 Kelley Parkway [,�In-House SAC Det�°°'�tion Form Completed <br /> � , Crystal Bay,MN 55323 _`�1 ' }'� .�j'l c� _�-��,�.,�s�( � �� <br /> ',;�� ��� (952)249-4600/Fax(952�249-4616 approved By(If Required): �J <br /> � <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may requirc approval by the Building Official and/or Public Works Departmcnt*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoalication 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 A 1 <br /> �.ltesidential(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: � �I�Q � lA�������'��' ��� �,��'li �1��� <br /> S�t� m��l��� n ` � � ���� <br /> Owner: � �. ��� Mailing Address: f�`�� J�tle �iYt�(, �� ��l <br /> City: / '�1 ih I��,'�'b� ����� Zip: �7 5,���� <br /> Home Phone: -I Sa'��I� "U-S `I �� Alternate Phone: <br /> Contractor Information: <br /> Contractor: ��V��� � ��� ContactPerson: ���'' ��� <br /> Address: � �����( �� �� J State License#: <br /> �4� <br /> City: ���� Zip:S� �J Expiration Date: <br /> Phone: "l�S�� "I��1' CI��� AltematePhone: ���-�� t - �Ui7 <br />