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. <br /> � FOR CITY USF ONLY <br /> ����� Clty Of�1'Ono Date Received: Permit# <br /> P.O.Box 66 <br /> �' 2750 Kelley Parkway <br /> , In-House SAC Determination Form CompleYed <br /> a ��'E� a Crystal Bay,MN 5�323 � <br /> �d� � '"�,�o� (952)249-4600 Approved By(If Required): <br /> �'4g�BA08 <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 application 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. Pernut 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 pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Deparhnent(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 wark must be inspected before it is covered. Call(952)249-4600, 24+hour notice required. <br /> TYPE OF PERMIT <br /> (Check All That Apply) <br /> '�Residential(May Require Approval) ❑ Commercial(Approval Required) �� <br /> ❑ New Connection �� � <br /> ❑Additional Connection ❑ Re-Connection ❑ Repairs � Disconnect i � ��L, <br /> ❑ Water Availability Connection For Future Hook-Up to Water V <br /> Job Site /Owner Information: �/ �� <br /> �. / <br /> Site Address: �� v��-� �� ��c��. .��' : <br /> / i <br /> Owner: ��� �/ S � Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> —� <br /> Contractor: �� �����`� r� -S! �--' Contact Person: �e�%�%�" C���✓�� <br /> Address: ���� ��'� � �� State License#: (�v`��� <br /> City: i��`�'�� � Zip:�3��� Expiration Date: �-���- 1 / <br /> Phone: ci S�� ' ��-�` `���( Alternate Phone: � ��- ���-4�� <br /> z <br />