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. <br /> FOR CITY USE ONLY <br /> 40� City Of Ot'ono Date Received`. , ' Permit# <br /> P.O.Box 66 <br /> ��,, � 2750 Kelley Park�vay ❑ In-House SAC Determination Form Completed <br /> a '�1���'� �. Crystal Bay,MN 55323 <br /> �'� �° � �� o'' 952 249-4600 Approved By(If Required): <br /> t��ti��,$4 � � � . . <br /> CITY OF ORONO—S�WER&WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Buildii�g Oflicial and/or PuUlic Works Department'`) <br /> (ALL PER�9ITS- A7av be subicct to further review and mav not be issued when the annlication is recci��ed) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pennits by mail or in person at the City offices. <br /> Z. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will <br /> be sent by rehirn mail witl�in 2 busuless days. <br /> 3. Pei•mits are not valid until you receive a pernut card. <br /> 4. Work must not begin unless the pernut card is available on the job site. <br /> 5. Utility connection perniits may be issued to licensed conhactors or�ly. <br /> 6. Contact the Public Works Department(952-249-4600) for utility shib as-built locarions. <br /> DO NOT ElCAVATE In ANY STIZEET AND DO NOT TAP ANY MAIN without express <br /> approval of the Public Vb'orks Department. Issuance of a pemut does not grant this approval. <br /> 7. All work must be done in accordance with State Code requuements. <br /> S. 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 App1Y) <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connecnon (�'ke-Connectioii ❑Repairs ❑Disconnect <br /> Job Site/ O�vner I�iformation: <br /> �---� `� � � `/ <br /> Site Address: �� � � �� � ��-� � �� - ��" , <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> � � � �� � <br /> Contractor: .,) ,S�i<�1�s � Contact Person: �����'' G'�� <br /> Address: ����i( C��• `�'�y • L`� State License #: (��`i�'� <br /> � <br /> City: �/�l ' �-�l Z:p:`�5��'�Expiration Date: �-2- �i z'� <br /> Phone: �c(� � � u 7�-y 7 S� Alternate Phoile: � �--� �`��l ��� <br />