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� <br /> . �, , ���5 <br /> � � <br /> FOR CITY L'SE ONLY <br /> 40� C1tV Of�COnO Date Received: Permit# <br /> O* O P•O.Box 66 <br /> �,; 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �a �1�'J�� +. Crystal Bay,MN 55323 � <br /> �� 11,1�;,,- <br /> �� r�y�o o`� (952)249-4600 Approved By(If Required): <br /> �rX�h�- 4• <br /> saxoe <br /> CITY OF ORONO- SEWER & WATER/ GENERAI, PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the a�plication is received) <br /> GENERAL INFORMATION <br /> 1. 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 pernut 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 utiliry 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 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 /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site / Owner Information: <br /> Site Address: ��j"a 1 ��i, � i�u�' �� <br /> Owner: ���,�� ,�'ru{�'`�►� Mailing Address: ���'Z(� <br /> City: �/=- , *�c _ Zip: ��.�aJ� <br /> Home Phone: � l�7�-.3�/-�"'`�a 7(� Alternate Phone: ���-��/-7y�� <br /> Contractor Information: <br /> � h ��"k�" �on c�t Person: �,� Z <br /> Contractor: <���fyr7� l�; Gt 1���� <br /> Address: t�`, `,��,�d Sd- State License#: ���/ <br /> City: l" �,'�itt�n��1 i5 Zip:�/l Expiration Date: <br /> Phone: 7�� - a-Y S �`7�"�� Alternate Phone: 5�•-��e' <br />