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� �� <br /> POR C[Tl`USI;ONLl' <br /> ��"'�`-> City of OCOnO Date Reeeived: Permit# <br /> /;.:�`, ,�;;.� <br /> ;!O O�';� P.o.Bo.66 <br /> 27�0 I`elley Parkway ❑In-EIouse SAC Detennuiation Form Cotnplefed <br /> �(.� ii}'�, :�I Cnstal Bay,b4N��323 <br /> ����K�Ho�ec,�� (9�2)249-4600 Approved I3y(IfRcquircd); <br /> Cl'TY OF ORONO—SCW�R & WATER/G�1��12AL P�RMI'I' <br /> (K 1otc:Some permits mav requirc approval by Ihe Building Offieial and/or Public lVorks Dcpartment*) <br /> (;1LL PI;Ri�IfI�S- �'iav bc sublcct to furthcr rc��icw and ma�'not bc issuecl�shcn�hc applico-i�ion is recci��cd) <br /> GENCRAL 1NFORMATION <br /> 1. You may appfy for utility permits by mail or in person at the City offices. <br /> ?. Mailed in applications are subject to tile postage and handliil� fee showii belo�v. Permit cards�r�ilf <br /> be sent bv return mail �vithin 2 business days. <br /> 3. Permits are not valid until you receive a permit c1rd. <br /> 4. �Voii. nwst not begin unless the permit card is available on thejob site. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> 6. Cont�act the Public �Vorks Department(95?-249-4600) for utility stub as-built locations. <br /> DO NO"C E\CAVA'CE 11�' ANV STRLET r1ND UO NOT TAP ANY NIAIN without express <br /> �pprov�l of thc Public�Vorl<s Department. Issuailce of a permit does i�ot grant tltis appr-oval. <br /> 7. All work must bc done in accordance with State Code requirements. <br /> 8. All worl:must be inspected beforc it is covered. Call (952)249-4600,24+hour notice required. <br /> TYPE OP PERNIIT <br /> (Check All That Apply) <br /> ��Residential (May Reqiiire Approval) � Commercial (Approval Reqt�ired) <br /> � New Connection �, Additional Connection � Re-Connection �OJ Repairs � Disconnect <br /> Job Site/ O�vner Information: I <br /> Site Address: �� !.—� . e ��=v f'`` `� �� <br /> �-}�. n �� , �^� /r � ,Q� <br /> Owne��Q, 'r�f.��- 14c�rti J� sp'� Iviaiiing Acicicess: ��� � (- < ''.��J f"I� �5 y� <br /> c�t>>: ���24�� m-� . z���: �5�535/ <br /> 1-(ome 1'IZon��_5 2J ��� ^'� �/5 Altecnate YllOtle: �� � �,3`����,J <br /> � �,011ll'aClOI' jlltOl'I11a11011: <br /> I <br /> � <br /> r-- �. � ��r �--� C:6 - ��`,�-, �r�-E e�h��,-► <br /> Coiltrlctor: -G 5 Contact Pecsori: �' <br /> ;'lddi-ess: 5 �2( 'Da9�'-e ��z��, State License #: 2 � � <br /> City: ,V��G�v _ 7.,ip:ss�� Expiration Date: <br /> Pllonc: ��43 ��2"2�26 _ Altecn�t�ePho�le: ���2 ZC>Z��J��� <br />