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� � �( <br /> � � <br /> /� <br /> � <br /> � . ,�' TOR CI'I'1'L1SE ONLY' <br /> � ,:��`�;,, C►ty Of OYOnO /� Date Received: Pemlit# <br /> !i, `y `� P.O.Box 66 �� <br /> �,� . �\';� 27j0 Kelley Park��ay a ❑In-House SAC Detennination Form Completed <br /> ��� tl''� �•�� Crystal E3ay,MN��323 � <br /> A ' <br /> �����}p4y`� (9�2)249-4600 Approved I3y(IfRcquircd): <br /> CITY OF ORONO—SCWE12 & WATER/ GENEI2AL PERMIT <br /> (*\ote:Some pennits may require approval by the Buildine Official andior Public\�✓orks Departmcnt*) <br /> (ALL PGRi�11TS- AIa��bc subiect lo fw-tl�cr revic�v:ind may not be issuccl�vhen thc��nnlicalion is rccei��cd) <br /> �GCNERAL INFORMA'1'fON <br /> 1. You may apply for utility permits by mai(or in person a: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 �vithin 2 business days. <br /> 3. Permits are not valid until you receive a perniit card. <br /> 4. �Vork must not be�in unless the pennit card is available on the job site. <br /> �. Utility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Deparhnent(95?-249-=1600)for utility stub as-built locations. <br /> DO NOT EYCAVATE 1N AhY STR�E1'AND DO NOT TAP ANY iVIAIN without express <br /> �pproval of the Public Worl:s Dep�rtment. lssuance oFa permit does not grant this approval. <br /> 7. fUl work must be done in accordance with State Code requu�entents. <br /> 8. All �vork must be inspected before it is covered. Cail (952)2�9-4600,24+hour notice required. <br /> TYPC OF PERMIT <br /> (Checic All That A I ) <br /> '�Residential (May Require Approval) � Commercial(Approval Reqtiiced) <br /> � New C�oni�ection �, Additional Connection �]Re-Connection � Repairs � Disconnect <br /> Job Site / Owner Information: I <br /> �,-- `1 -,� . <br /> Site Address: � ,3_S'�(o L��,rc S fa r� ,�-v-2. <br /> �� <br /> Owiler: 1�G'���,ew L�o�� ,:� Niailiil� Acidcess: <br /> City: � �C�Y�l.�' 7ip: S _�'.3 �i � <br /> Home Phone: �� `—��/2, y Ll Sy niternate Phone: <br /> � Contractor I��formation: <br /> � <br /> C011tl'aCtOt': ��C✓( �C Contact Person: �ve �<6�°'� <br /> Address: s��1`�J/2%«^C S f State Liceilse #: Z�� ���1 <br /> City: Y,%�ce 7ip:� Expii•ation Date: — — — — �— <br /> I'llone: 7is'- Zh(� �-/�,/� Alternate Phone: <br />