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s <br /> ~ �A S:y,.i �S 1�L WJ�LX/"`� : ���1-� <br /> i�—'�_ � ,F�O/�USE O�'LY.�„l� ��U <br /> % ������ Cl Of�r0I10 Date Received� /�Pennit#�U <br /> i P.O.Box 66 <br /> I 2750 Kelley Parkway ❑In-House SAC Detennination Form Completed <br /> �: � ,� ' Crystal Bay,MN 55323 <br /> \� � (952)249-4600/Fax(953)249-4616 Approved By(If Required): <br /> �kE�SMo�'� <br /> �. <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*M1ote:Some pennits may require approval by the Buildi�g Official and/or Public Works Deparhnent*) <br /> (ALL PERMITS- Mav be subiect to further review and ma�•not be issued when the aoolication is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits 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 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 permit 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 the Public Works Department. Issuance of a permit does not grant this approval. <br /> 7. All wark must be done in accardance 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 /> D�New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: i L 5� 1 i�. � �c�..�_ _ '�>�� .5�.S ���'l���f fi <br /> Owner: ? ��` •_�;�,._ �� _:..`� Mailing Address: `( `i.;_ ;t�• ")c��- j K � <br /> City: ��._ .�,_ �. Zip: ��j ,.� �. <br /> Home Phone: ��� � � �� 3 � �`'� Alternate Phone: <br /> Contractor Information: <br /> Contractor: `=• �ti��..-•�°;,� �_ . ._ -,_ -,,_: Contact Person: i��.�.� - <br /> Address: i' �. 3��r 3��:- State License#: '— s'� � �- <br /> City: 1�_-��. Zip:`�:>"S� Expiration Date: �Z� �� Z��1 <br /> Phone: � ' � ' ? Alternate Phone: �'. S j 1�� b�� � <br />