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. <br /> ,. -� FOR CTI`Y U�E ONLY <br /> ���NO�� City Of Ol'ono Date Received: ///� Pemzit# �c(� �(,oz C� <br /> � � P.O.Boz 66 <br /> ; 2750 Kelley Parkway ❑In-Hoese SAC Determination Form Completed <br /> �i� � Z-�' Crystal Bay,MN 55323 _ d <br /> `\`'� .�'� F�f (952)249-4600/Fax(952)249-4616 Approved By(IfRequired): dj�//tpC=�" <br /> '�'�is�io�'j <br /> —_____•- <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permiu may requ've approvai by the Building Official and/or Public Works Departrnent') <br /> (ALL PERMTI'S- Mav be subiect to further review and mav not be issued wLen the aoolication is receivedl <br /> GENE�tAL IIVFORI+�ATION <br /> 1. You may apply for urility permits by mail or in person at the City offices. <br /> 2. Mailed in applications aze subject to the postage and handling fee shown below. Pemut cards will <br /> be sent by retum 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 pemiit card is available on the job site. <br /> 5. Urility 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 PER1vI�T' <br /> Check All That A 1 <br /> I.�f Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> `1` <br /> ❑ New Connecrion ❑Additional Connection ❑ Re-Connection ❑Repairs �Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Orvner Ir�orrnation: <br /> f r ' <br /> Site Address: �����S L- l'��.��i.': ; 1 .�.,=� � �-''� <br /> Owner: �� !;,.�� � ,^�-�.�- '� Mailing Address: 'I �(b /l;r.. ���`,� r� <br /> City: I}l�`.�,,T�%� Zip: 53��� ..7 <br /> Home Phone: ��R.� �� �S� I �l�L� Alternate Phone: <br /> Contractor Information: <br /> �. /� � � ) <br /> Contractor: �C' f �-t � tn-� .' � �� Contact Person: �_l�I �i. ; 1 �r ��j..� ,�- <br /> Address: J"C��� l� 7���� ���� �``` State License#: <br /> City: `-�"< <' � ���� Zip:�-�`/p Expiration Date: <br /> '? <br /> Phone: -�/�� .�-7 `�r�� 7 Alternate Phone: <br />