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FOR ITX USE ONLY /�' � <br /> ¢��` City of OI'ono Date Reccived: '� ^��1� ' Permit# (���/� ." <br /> "r P.O.Box 66 <br /> ��;; � 2750 Kelley Parkway ❑ 1n-House SAC Determination Fonn Completed <br /> a '�j`'`'��'�=_ � Crystal E3ay,MN 55323 <br /> ��+ y'.��''�o~ (952)249-4C00 Approved By(If Required): <br /> t,���?1��,w <br /> CITY OF ORONO -S�WER & WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Ofticial and/or Public Works Department*) <br /> (ALL PFRMITS- Mav be subiect to further rcvicw and mav not be issued when the annlication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pennits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown b�low. Permit cards will <br /> be sent by retw-n mail within 2 business days. <br /> 3. Permits are not valid until you receive a permit card. �`�y.r N�• /=�"`� <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 conhactors only. �r � ""'S +� <br /> 6. Contact the Public Works Department(952-249-4600) for utility shib as-built 1 � �5 U"���"�O <br /> DO NOT EXCAVATE Il�'ANY S'I'REET AND DO NOT TAP ANY MAIT �� Q <br /> approval of tlie Public Works Department. Issuance of a permit does not gr �/G �� �J° � <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+hou <br /> TYPE OF P�RMIT <br /> (Check All That Apply) � � � <br /> �(Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> � New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: 70/ L7i�keu �a� ��i v e <br /> Owner: �.GLt�.G� �l%D� Mailing Address: 1 Z� �.(J�� c�/�wKc� <br /> .J <br /> city: �r�i K2a�/�i� zip: �S Yl/ <br /> Home Phone: �oS!- Z75-'l.S-(o0 Alternate Phone:/� �O�Z- 2�-+�/S Z <br /> Contractor Information: �gD _ �„„-F,rq�� be �tpProvc�! �y c:�y �,�� � S'�.��� wvrk, <br /> Contractor: Contact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br />