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FOR crT u��oNi.v f�- , ` <br /> ,,,��-��/�f{� Clty of OI'ono Date Rcceived: _�1 ��i�-r Pcrmit# •4 i�j �"/' _!"1 y Y <br /> P.O.k3ox 66 <br /> ,�� 2750 Kelley Parkway �"In-House SAC Detennination Form Completed <br /> r , Crystal Bay,MN gj323 � : <br /> z ���w; (9�2)249-4600/Fax(952)249-4616 Approved B}�(If Required): �� <br /> ti,�b, , � � <br /> CITY OF ORONO— SEWER & WATER/GENERAL PERMIT � : � r �/ <br /> *Note:Somc �rmits may re uire a roval b the Buildin Official and/or Public Works De �rtment* '���� ��� �� <br /> � P' 9 PP )' � P� ) , <br /> (AI,L PF.RMITS- Mav be subiect to further review and mav not be issued when the application is received) � �� ��� <br /> GENERAL INFORMATI�N <br /> 1. You may apply for utility permits by mail or in peison 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 tlie 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 lV1AI1�1 without eYpress <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) ❑ Commercial (Approval Required) <br /> . <br /> �i <br /> New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect <br /> ❑ Water Availabiliry Connection For Future i-Iook-Up to Water <br /> Job Site / Owner Information: <br /> Site Address: ��0 � �(7 GU ;it I `U <br /> Owner: V �'`'��f� ���'�� Mailing Address: ��� �. V/�/''��►�. � <br /> / �� � <br /> City: o A.G� Zip: ]�')P�.� �1N ��`/�- Z <br /> Home Phone: Alternate Phone: �lo,.�- `�7�3� _�`S�� <br /> Contractor Information: <br /> Contractor: �Vl�;�e:� � v Contact Person: � �c ����(�'� i� <br /> Address: ��(� 7� �� State License #: ��-�(s Y�/c�'�_ <br /> City: �0� ,��:�v- Zip:s-��-iJ Expiration Date: I�-31 - �� <br /> Phone: �f.�'��2"3�� -� Alternate Phone: l4�a.-��'� I �.3 <br />