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Rc�ivED ��j'� <br /> ,,�---��, '`� FOR CITY(JSE 9NLY O <br /> 4•�/�/O City of Qrono , DateReceived: Pera�t�f � <br /> 1 e! . <br /> P.O.$ox 66 0� i <br /> 2750 Kelley Parkway M AY � 1 � ❑In-House SAC DetemainaHou Foim Completed <br /> y � Crystal Bay,MN 55323 <br /> f�qACS HOR/�� (952)249-4600/Fax(952��gQ,-q63i�OR�N(� APproved Hy(If Required): � � <br /> �I Y v <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department") <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoallcation is receivedl <br /> GENERAL INFORMATIOI�1 <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-buiit locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express <br /> approvat 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 norice required. <br /> TYPE OF PERMIT <br /> Check All That A 1 <br /> ❑Residential(May Require Approval) ❑Commercial(Approval Required) <br /> �New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site!Owner InfQrmation: <br /> Site Address: ��� �'"� ��i���-•-�-"- � � � <br /> Owner: L���'�����-� Mailing Address: <br /> City: d � v,�..-u Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> �� � � <br /> Contractor: �11�a µ�� ��-5 Contact Person: ��-�. 5��� <br /> Address: ��y° � �a e-� 3 State License#: Q i� ��C�-/`'� �3 <br /> City: K�Q�'"-`�S Zip:SS 3y3 Expiration Date: �2-I3 �1�� <br /> Phone: `�SZ `/S� '���'� Alternate Phone: �� 2 `�3 `� 2�S� <br />