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. <br /> . . ?,� <br /> - EOR CITY USE ONLY <br /> �0� City of Ot'ono Date Recerved: ; ,: .Permit# <br /> O A Q P.O.Box 66 '. � <br /> 2750 Keiley Parhway ❑In-House SAC Determination Form Completed . <br /> a ��'�y �t�. Crystal Bay,MN 55323 ' <br /> ��'���;�a���� (952)249-4G00 Approved By(If Required): <br /> CTTY OF ORONO—S�WER&WATER/GENERAL PERMIT. <br /> (*Note:Some permits may require approval by the Building O�cial and/or Public Works Department") <br /> (ALL PERMITS Niav be subiect to further review and mav not be issued when the annlication is received) <br /> GENERAL 1NFORIVIATION ' <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> Z. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will <br /> be sent by reh.uzi mail within 2 busuiess days. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the peinut card is available on the job site. <br /> 5. Urility comiectio�i 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 pernut does not grant tlus approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> S. All work inust be inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> , TYPE QE PERlV1IT ' `. <br /> ; .: <br /> (Cfieck All That A"`'ly) <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connecrion ❑Re-Connection ❑Repairs �Disconnect <br /> Job Site/ Owner Information: ' <br /> Site Address: �✓�i�' �Or✓� ��� ,�/l/Gf ' <br /> Owner:��1�4'r�"/"��r� Mailing Address: f O .L �!�/va/. <br /> City: �Gh/� ' Zip: <br /> Home Phone: Alternate Phone: �,2 —�32� — /`�✓�j� <br /> Contractor Jnformation: <br /> Contractor: � „��l,j� Contact Person: �<... ��. <br /> Address: J��D �1'�l1 pC 3� State License#: o V� <br /> T <br /> City: YI� .S Zip:��t� Expiration Date: �DO S <br /> Phone: lo.�� 0��� '�s�� AlternatePhone: �0�- ��5�����" <br />