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----- . FOR CiTY USE ONLY <br /> �f��� �r���•` City Of�OrUnO DateReceived: ____ Pc;rmit# <br /> ,� P.O.Box 6b <br /> I �� 2750 Kelley Parkway ❑In-Flouse SAC Determination Form Completed <br /> a , .�,�� Crystal Bay,MN 55323 <br /> `��-�*'� (952)249-4600/Fax(�JS?)249-4616 Approved By tif Required): _ <br /> a, ,�f:'/ <br /> CITY (JF ORONO—SEWEIZ& WATER/GENERAL PERMiT <br /> (*Note:Some perniits m�y require approvai by the Buiiding OfticiaE andior Pubiic Works Department�'1 <br /> (ALL PERMITS- Mav be subicct to further review and mav not be issued Nhen the aoalication is received) <br /> GENERAL INFORMATIUN <br /> 1. You may apply for utility permits by mail or in person at the City ofTices. <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 busine�s days. <br /> 3. Yermits are not valid untit you receive a permit card. <br /> 4. W�rk must not begin u��les�the pera��it card is a��zilabte en thP jo�si?e. <br /> 5. Utility connection pennits may be issued to licerised contractors only. <br /> 6. Contact the Public Works Department(952-249-4600}for urility stub as-built locations. <br /> DO NOT EXCAVATE iN ANY STREET AND DC)NOT TAP ANY MAIN without express <br /> approval of the Public Works Department. Issuance of a permit does not grant this approval. <br /> 7. Ail work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it i;covered. Ca1[(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 /> S�.��v <br /> �� New Connection (,�]Additional Connection (� Re-Connection [-]Repairs [�Disconnect <br /> Q Water Availability Connection F'or Future Hook-Up to Water <br /> � Jab Site/Owner Tnformation: <br /> Site Address: �� � �'�'�C�C�-�'� �(� � <br /> Owner: �(��t1V '�JY�'-D�.� Nfai ling Address: ��� ��,(/{���Q_�"� <br /> City: ��� .�; L� Lip: ��-�'� � <br /> Home Phone: Alternate Phone: <br /> Contractor Inforrnation: 1 <br /> __� <br /> Contractor: ��,�,� .�,1/�l� ��� � �t� Contact Person: �' l✓i�-l:� <br /> Address: �( O�C L��Cl.l1Y�,�'��Q.I�State License#: <br /> City: ��� iT Lip�J�f Expiration.Date: <br /> Phone: 7�"�-y-Z�—�L��L� Alternate Phone: ��� �� �' ���r� � <br />