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+ i <br /> • EOR CITY,USE ONLY � <br /> ��� Clty Of Ol'ono Date Recerved.,! Permit# �_ .; <br /> O� Q P.O.Box 66 - � <br /> i <br /> � ❑In-House SAC Determmation Form Cum leted . <br /> 2750 Kelley Parkway p <br /> � ���'���'�. � Crystal Bay,MN 55323 ApproVed By(If Required) <br /> ���`���'i�,�o (952)249-4G00 I <br /> ��ga� <br /> CITY OF ORONO-SEWER&WATER/GENERAL PERMIT � 5`��� <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) I <br /> (A�.L PERMITS- NI�v be subiect to Curther review and mav not be issued when thc annlication is receivec�) �� <br /> �I/�'��'' <br /> GENERAL INFORIVIATION ' <br /> 1. You may apply for utility pennits by mail or in person at the City offices. '! <br /> 2. 1�blailed in applications are subject to the postage and handling fee shown below. Pernut cards will <br /> be sent by reriu7l mail within 2 business days. i <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the pernut card is available on the job site. <br /> 5. Urility connection pernuts may be issued to licensed contractors only. 'i <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�xpress <br /> approval of the Public Works Department. Issuance of a pemut does not grant this ap�roval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 8. All work�nust be inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> - : TYPE OF`PERIVIIT <br /> � (Check All That Ap ly) `.. t <br /> ❑ Residential(May Require Approval) ❑Comnlercial(Approval Requued) ! <br /> �New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Discqnnect <br /> Job Site/ Owrier Information: ' <br /> 'te Ad ress: <br /> O �'✓� _ J'� <br /> Si � � � <br /> Owner� G��r- Mailing Address: � �✓�' I - �� <br /> City: �- Zip: �����.le <br /> Home Phone: ��� �f 73 4'��/� Alternate Phone: I <br /> Contractor Information: <br /> � ' r <br /> Contractor:,(/�� f,��-����--�'L�Contact Person: �-- <br /> Address: �/ 2 U ���ax � State License#: ( �� l I <br /> City: /��� Zip:�7�Expiration Date: �� '_��� �'� <br /> Phone: ��� � 7� �� `f`� Alternate Phone: �f Z '�l � '�Gf � � <br />