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t � ^ <br /> %`�`�- � F CI' Y�USI;ONLY,,, -7 <br /> i ��L I`/ City Of 01'On0 Date Received: Pem�it#D«�l - Q /� <br /> � �\ P.O.Box 66 <br /> � � 2750 Kelley Pazkti�ay ❑In-House SAC Determination Form Completed i <br /> ���y � �r' Crystal Say,MN�5323 � <br /> �`�����, t��,�' (952)249-4600 Approved By Qf Required): <br /> c�F�o , <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- Mav be subiect to further review and mav not be issued when the aoplication is received) <br /> ''GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the Ciry offices. <br /> 2. Mailed in applications are subject to the postage and handlinb 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. ConCact 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 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: 3 Lt�s �r��sd*l �c�c/ /�� <br /> v - __ <br /> \ <br /> Owner: U(��'i'r�' ��,��i;z(Cf MailingAddress: 3�-(�� �r��� � �S'u� ��✓ <br /> City: V rU/t U Zip: -� J 3 �� <br /> Home Phone: �S� �7� �(�� � Alternate Phone: <br /> Contractor Information: <br /> � � �1�.,.���h� � � <br /> Contractor: �yt�crrr��� �n�['�,;� Contact Person: 0V pd� ���,� <br /> Address: �L/�`l ��� .S c� /�/ State License #: ��� � � <br /> City: ��� Zip: �S�l/ Expiration Date: � �� ��� � <br /> Phone: �G�"�`Y�� ��'6v Alternate Phone: S«�"'� � <br />