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FOR CITY USE ONLY <br /> �%���, Clty of Ol'ono Date Received: Permit# <br /> 1/f� '�O P.O.Box 66 �� <br /> t a'.,,,,�,. 2750 Kelley Pazkway ❑In-House SAC Determination Form Completed <br /> � y�1'x. �. �. Crystal Bay,MN 55323 ^� <br /> ��� '�+��`:,,*�o�' (952)249-4600 Approved By(If Required): /J�' <br /> \\�ss!/ �v � <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT UU <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 not be issued when the aunlication is received) � <br /> GENERAL INFORMATION �/ <br /> � � � <br /> 1. You may apply for utility permits by maii 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 egpress <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 /> ,�esidential(May Require Approval) � Commercial(Approval Required) <br /> �New Connection ❑Additional Connection �Re-Connection �Repairs ❑Disconnect <br /> Job Site/Owner Information: <br /> Site Address: 30�i'D F�J��� �M�, <br /> Owner:�.r'-�f�ta�1��M i�(�- Mailing Address: <br /> c�ty: �na z�p: 55 3�3 <br /> Home Phone:9�� -��N-2-��y Alternate Phone: <br /> Contractor Information: <br /> Contractor: Glenn Rehbein Exc, Inc. Contact Person: John Carlisle <br /> 8651 Naples Street NE ���8 <br /> Address: State License#: � <br /> C�tY� Rlaina Zip:5544q Expiration Date: I.Z �� ���7 <br /> Phone: (612) 919-2019 Alternate Phone: (763) 784-0657 <br />