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REC��W�D <br /> �1AY 31 2017 �,� J,� <br /> �� FOR G'II'1'USE ONLY <br /> 4-�N\� City ot Qrono Date Rccei.�ed: Perc►�it <br /> � P.O.$ox 66 �++�-�����1��� � � � <br /> 2750 Kelley Pazkway r,�,, ❑In-House SAC Detetmination Fom►Completed <br /> y „ Crystal Bay,MN 55323 <br /> `'�,��C5}"�p�� (952)249-4600/Fax(952)249-4616 Approved By(If Rgquired): <br /> __-- <br /> CITY qF ORONO—SEWER&WATER/GENERAL PERMIT <br /> (*Note:Some permits may require appmval by the Building Official and/or Public Works Department") <br /> (ALL PERMITS- Mav be subiect to further review and mav not be issued w6en the aonlicadon is received) <br /> GENERAL INFORMATION <br /> l. 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 maii 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 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 notice required. <br /> TYPE,QF P�RMIT <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/Qwner Information: <br /> Site Address: �� Gl � �"� �s � �-'`�-�''" � � <br /> + � y� A i <br /> Owner: W c�aU\ �-` -� Mailing Address: <br /> City: ��f`� �� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information, <br /> Contractor: a 1,�r ��� .Sc��-S Contact Person: <br /> ,/�'���..-� S��1 � <br /> Address: `�`�°� �� e� 3 State License#: �g� y`�`( �3 <br /> City: H�p�-;�S Zip:s y 3y3 Expiration Date: ( Z--' 3 �� ��" <br /> Phone: `�SL y�� `{��3 Alternate Phone: �� 2 `�3 `� 2y S`i <br />