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t � �" • <br /> FO C7R/ 1'j'Y�JSE ONLY OI 7 'D �'S� <br /> �����%�,�r Clty o1��1'oRo Date Received:�-���� Permit N � <br /> \� P.O.Bux 66 ~ <br /> �� 1� 2750 Kelley Parkway ❑In-House SAC Detenninatiou Form Completed <br /> {, \ � � Crystal Bay.MN 553�3 <br /> �� ��^� � j (952)249-4600/F�x(952)249-4616 Approved By(If Required): <br /> CiTY OF ORONO-SEWER & WATER/ GENERAL PERMIT <br /> (*Vote:Some permits may reqiiirc approval by the Building Official nnd/or Public Works Department*) <br /> (ALL PERM11'S- Mav he subiect to further rcview and mav not be issued H'hen the apnlication is received) <br /> GENERAL 1NFORMATION <br /> l. You may apply for utility permits by mail or in person at tl�e City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will <br /> be sent by retum inail within 2 business days. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless tl-,e permit card is available on t1�e job site. <br /> �. Utility connection pernlits may be issued to ticensed 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 MA1N without express <br /> approval of the Public Works Department. Issuauce of a permit does not grant this approval. <br /> 7. All work must be done in accordance with State Code reqtiirements. <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 /> (�Residential(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: �G�`� G%�E:�l� .�Z /l7� �f94� <br /> Owner:.- �ti/�iV d!"'i�t,l�.�tv:��b1�//U Mailing Address: I Z�� f-l�/i/'�T�'ti��1=��G'Z; <br /> City: ���I_ 3"-u�h!�L- Zip: ��3 5�1 <br /> Home Phone: �- Alternate Phone: ( <br /> Contractor Information: <br /> Contractor: �,(,l2itl5 �5��'I�,ifl�71�2;G� Contact Person: S�l�-�l L �C•L,�/L15 <br /> Address: �z-(7L,� �'L�L/,�1,�%Zl-�Z j State License #: - "-_lZ <br /> City: � Zip: `��� Expiration Date: <br /> Phone: �C1SZ GI���l/Z Alternate Phone: ��d%?� �KS'L/.��.3 <br />