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. • � ' <br /> P'OR CITY USE O�`LY <br /> City of OrOno Date Received� Permit i� � <br /> ��"�'� P.O.Box 66 <br /> � ��� 27�0 Kelley Parkway ❑In-House SAC Detennination Form Completed <br /> ,� <br /> i"� �.�' Crystal Bay,MN 55323 A roved B If Re uired�� <br /> �`a+ �� � 8`� (952)249-4600 pP Y( 9 )� <br /> ��exabso�4% <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> ('"Note:Some permits may require approval by the Building Ofl�icial and/or Public Works Department*) <br /> (ALI PFRNIITS- Mav be subiect to further review And mav not be issued when the aonlication is received) <br /> GENERAL INFORMATION <br /> L 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 /> �Residential (May Require Approval) ❑ Conunercial(Approval Required) <br /> [�f 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� �l�� t�� �(C/�� ��I�S S <br /> Owner:��IC�12' .—�Lc )���E F F��Z Mailing Address: ,���I D Z �� ti'�-� ���-= �� <br /> Citv: ��ItIMbL«"1+ Zip: SS�/�ICO <br /> - ---r <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: �L.(.Izi�ia ��ll_'�Vl977P�, Contact Person: S 1���%L�� ��t.�N�- <br /> T�tt:� /�� � S E=(�?"c L <br /> Address: ��17U CD IZC_I Z l State License#: f'1"��=- �vt';� �" �OD3 — Z���� <br /> City: M Zip:��P��Expiration Date: l�`'1i`I,PC'�ff ZGIZ <br /> Phone: ��SZ� ��� -3/!1� Alternate Phone: ��Dl��. �SS � '��d� <br />