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• + <br /> FOR C[TY USE ONLY � <br /> f'-' G) � <br /> � ,��� City of OCono Date Received: _�L Pem�it# �t%� <br /> O} O P•O•Box 66 r,� `� <br /> �,�`,s„ 2750 Kelley Parkway [� [n-House SAC Determination Form Completed ' � .�"1���f 1�' <br /> .� �j?'>�,�� Crystal Bay,MN 55323 `y� ` <br /> ������i�..�o� (952)249-4600 Approved By(If Required): Y_ <br /> 0 <br /> CITY OF ORONO —SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Vlav be subiect to further review and mav not be issued when the annlication is received) <br /> GENERAL INFORMATION T <br /> 1. You may apply for utility pernuts 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 pernut card is available on the job site. <br /> 5. Utility connection pernuts 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 peimit 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: ��� ��,c ��2�� ��� <br /> � I <br /> Owner. �, �b�1 �P;���� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: � .� � Contact Person: �r c�.•r ����� � <br /> Address: l�a State License #: C���Y`��� <br /> City: c�✓'l Zip: 5"5�� Expiration Date: 1�— ���-�5 <br /> Phone: ���1 �?� �l s( Alternate Phone: � �.� � ��� � <br />