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� - <br /> FOR IT USE ONLY J ^'� <br /> � ���/� , Clty Of Ot'On0 Date Receivec� �Permit# Q�__�,� � ��"� <br /> P.O Box 66 <br /> � 27�0 Kelley Parkway ❑ In-House SAC Determination Form Completed <br /> , � Crystal Bay,MN 55323 <br /> �'��,�Y� t��-` (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> ^�si�,,a , <br /> CITY OF ORONO - SEWER & WATER/ GENERAL PERMIT <br /> (*Note:Some permi[s may requirc approval by Ihe Buildin�Official and/or Public Works Department*) <br /> (ALL PERbIITS- �Iav be subiect to further review and mav not be issued when the ann�ication is received) <br /> GENERAL 1NFORMATION <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 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. 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 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: ��SS ��r►m S-�. <br /> Owner: 5;,1,� C�,:,,�, I-�,�„� Mailing Address: 1`�22G fi,as«,�1- S{-. ►�,w <br /> City: (�vr�s� Zip: SS3b3 <br /> Home Phone: c.ai2 zzt-t-�3 Alternate Phone: 2�3 3�,i-7�4�Z <br /> Contractor Information: <br /> Contractor: 1�. ��� ��r� Contact Person: ��,�� <br /> Address: ��� ���� � State License #: Z.-7z-� <br /> City: �Ar,�-- Zip: ��►� Expiration Date: <br /> Phone: 1�i2 22��i�g3 Alternate Phone: ��2 Zz-�- �,.53Z <br />