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i <br /> EOR CIT�USE ONLY�✓7C �� <br /> ��� City of Ot'ono Date Received: 1G'1ti • Permit# �/ � , <br /> P.O.Box 66 <br /> �� � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> a ������ �* Crystal Bay,MN 55323 <br /> '� � 4-` ti A roved B If Re uired <br /> ��q�,,��i��o (952)249-4G00 PP Y� 4 )� <br /> '�$axa <br /> CITY OF ORONO — S�WER & WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Ofticial and/or Public Works Department*) <br /> (ALL PER�4ITS Niav be subicct to further review and m�v not bc issued�vhen thc anp��cation is reccived) <br /> GENERAL INFORMATION <br /> 1. You may appiy for utility pennits by mail 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 rehu�l mail within 2 busuiess days. <br /> 3. Permits are not valid until you receive a pernut card. <br /> 4. Work must not begin unless the peinut card is available on the job site. <br /> 5. Utility connection pernuts may be issued to licensed conhactors only. <br /> 6. Contact the Public Works Department(952-249-4600) for urility shtb as-built locarions. <br /> DO NOT EXCAVATE IN ANY STI2EET AND DO NOT TAP ANY MAIN���ithout express <br /> approval of the Public Works Department. Issuance of a pemut does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> S. 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 APP1Y) <br /> ❑ Residential(May Require Approval) ❑ Conm�ercial(Approval Required) <br /> �New Connection ❑Additional Connecrion ❑Re-Connection ❑ Repairs ❑Disconnect <br /> Job Site/ O�vner Information: <br /> Site Address: �� �� ��yKz�<zG'" %�='"� <br /> � � <br /> Owner:�j a^'�� ✓��� „����` Mailing Address: �� ,��`��-a����-- ��� <br /> `% � ���5 L� <br /> City: �� ,�%— Zip: <br /> ✓ <br /> Home Phone:��2 'Gf 7� c��,�� Altemate Phone: <br /> Contractor Information: <br /> �� �� <br /> Contractor:�.�/�:�,��,��ti��c'.��=�'�ontact Person: � %✓�`'v`���L <br /> Address: 7���'1���� �� State License #: 1`� � � <br /> City: ����a''�'� Z:p: S 5�7�xpiration Date: �� � �� " ` � �` <br /> ' 7 G �- (s /� - �%/ f — /�,��� � <br /> Phone: � � � � � � s �f t Alternate Phoile: <br />