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FOR C[TY USE ONLY <br /> ¢0�` City Of OCOnO Date Received: Permit# �� <br /> "Y P.O.Box 66 <br /> �;r;. � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed �'Z���� <br /> � ��j>>u�E'. �� Crystal[3ay,MN 55323 <br /> d�������o�o (952)249-4600 Approved By(If Required): �� <br /> sexo <br /> CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permits may reyuire approval by the Building Official and/or PuUlic Works Department') <br /> (AI I PERMITS- Mav be subicct to furthcr review and mav not be issucd when thc application is rcccived) <br /> GENERAL INFORMATION <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. Permit cards will <br /> be sent by rehirn 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 pern�it card is available on the job site. <br /> 5. Utility coimection permits may be issued to licensed conhactors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility shib 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 pernut 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 /> Job Site/ Owner Information: <br /> Site Address: �� t�t C� �� <br /> Owner:��yC ������./l,� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> i <br /> �r � � / <br /> Contractor�����U/ _-����--� Contact Person: � l � � ������� <br /> Address: ��S( �J � �� Y� State License#: ,�l � � <br /> City: ����"I �'-�GLfr���Lip;����GExpiration Date: � � � / � S-� <br /> Phone: �` � L[�?f G.� 7� � Alternate Phone: � / � �f � � 2 � � <br />