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bL <br /> �:O_- .� FOR CTI'Y USE ONLY� [�1. <br /> ��- �1O� Clty Of Ot'011o Date Received: Q jL�_��_ Permit# ��i � J <br /> i� + <br /> P.O.Box 66 -������`� <br /> � 1 ; 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> � � ,��' Crystal Bay,MN 55323 ,�j !�� <br /> J <br /> �\\1�t.�y'��j j (952)249-4600/Fax(952)249-4616 Approved By(If Required): �#�� � <br /> --- � I� � I� <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Deparhment') <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoalicatlon is receivedl <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City of�ices. <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 pernvt 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 t6e 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 /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> � New Connection ❑Additional Connection Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Conne i n For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: 1�� C�('�� �.�-�-� ('�;,��.. (Z� <br /> Owner:S��'\2, Liv,�����r.� Mailing Address: ��an �1'�,,�����`n{ �b <br /> City: o�, � Zip: 5�,��\ <br /> Home Phone: �\�-�`��;y-�a.�`-� Alternate Phone: <br /> Contractor Information: <br /> Contractor: �_� ,��" ,�.�f i ,,;,r;,,1�t Contact Person: (���� r���,;�, <br /> Address: 43(�� Q�,=� ,p� State License #: �� 3"�,�-r�t� <br /> City: wr.��c� Zip�"�f,� Expiration Date: ��-'�\ - �,(r, <br /> Phone: ��-Sa�t �`��11`i Alternate Phone: <br />