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� <br /> . <br /> �—O-. FOR ITY USE ONLY � �l /„ �/ <br /> �� �O� City of Oroao Date Received:b"�'/[�Permit# � � v �Y <br /> �` '; P.O.Box 66 <br /> 2750 Keiley Parkway ❑In-House SAC Determination Form Completed <br /> ���5 � Z-�` Crystal Bay,MN 55323 <br /> \``\��.�4j j (952)249-4600/Fax(952)249-4616 Approved By(If Required): <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 aot be issued when t6e aoolication is receivedl <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City of�ices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will <br /> be sent by retum 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 Departrnent(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 PER1VIiT <br /> (Check All That A 1 <br /> g] Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ( " <br /> j� New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑ Disconnect <br /> � ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> n <br /> Site Address: � FJ �� � ' -��r e�"� <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> C <br /> Contractor: ����� "� � Contact Person: ���`� —`�� <br /> Address: ��'� � - � � State License#: <br /> �! /' <br /> City: �C�-��'� Zip:�J�`-'�Expiration Date: <br /> Phone: �'�{?�-� �� Alternate Phone: � ��-7��-�77 � <br />