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,,.-�_ ------ - i�'�1RCITl'[�SEOM1Ll' —, <br /> �!`j"1��€���1�'; C;ify�f Or'ono Daie Ke�eived: --- Yennit# ------ <br /> P '' P.O.Ba�.hF <br /> � �� '� 2750 K;IIe��P�rk�ti�}� ❑Gi-House SAC Deterniination I�orm Complated <br /> t , ,�� Crvstal Bay,MN 5�i'- <br /> �� �'' (952)249-4600/I i�(9i;�_a.i-4b16 Apptuved By(11 Requiredl�. <br /> ;�,�,�,:i' ---- <br /> CITY OF ORONO—SEL�'ER & WATER/GENEI2�L PERMIT <br /> (*Note:Some permits iYiay reyuire approval b�the�3uild;nr Ol`ticial andi�or Puhlic Works Deparitient*) <br /> (ALL PI?R�7d"f'S- R1:���be subject to fi�riher revicw�and ma��n�t be issued when the anuiicatiun is received) <br /> GENERAI, INFOI�MATION i_ _ � "�__� <br /> 1. 1'ou may appiy for utility pennits by mail or in person at the City offices. <br /> ?. �iailed in applicatio�is<<re si�bject to the postage and handling fee shown beiow. Permit cards�vi(i <br /> be sent by return mail within?busir�ess days. <br /> 3. Permits are not valid un�il yqe� receive a perrnit card. <br /> 4. Work must not begin unless the�ermii card is available on the job site. <br /> 5. Utility connection permits ma��be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(452-249-4ti00j for utility stub as-buiit locations. <br /> DO NOT EarA�'ATE IN ANY'S'fREET ANI) DO NOT TAP AN1' VIAIN without express <br /> approval of the Public Works Deparkment. lssuance of a permit does not grant this approval. <br /> 7. All work must be d�ne in ac�ord�i�ce with �tate C'odc requireinents. <br /> 3. All�vork m�;st be ins��ected befor�it is covered. �all(952)249-4bCO3 2d+hour r�otice re�uired. <br /> -- ---7'YPE Q�=' PERMI"1' .�---`_----------1 <br /> ` (Chcck Ai( That ApplY) ✓-----------.�_,—� <br /> �Residential(h�1ay Require Approval) ❑Coinmercial(A�piova! Required) <br /> ❑ New Connection ❑ Additional Connection ❑Re-Connection ❑ Repairs ❑ Disconnect <br /> ❑ V4'ater Availability Connection For Puture Hook-Up to Water <br /> Job Site l Owner li�fof•matian: V� � <br /> Site ,�ddress: r.�S�foU �:�s�r�t'.�i��� ����` <br /> Owner• � /,;�cc.L'��� Mailin�; Address: �/�_9'_/�'� L��"� <br /> City: �/�l/!P/J Zip: � � -- <br /> Home Phorie: ���3 Alternate Phone: <br /> �ontractor Inf�rmation: —� <br /> Contt•actor: ;����cy �,�`�, Cc}ntact Persoi�: ,�lJ �� <br /> Add::ss: �.� State License #: !�/_��...7����_ <br /> f'ity: Zip��S�f Ex�irat�c�r� Date: �—�����-._ <br /> Ph��ne: � ��,3'�D��� __ �Ite►•rtate Phor�e: 1������� <br />