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P FOR CITY USE ONLY <br /> City of OronO Date Received: Permit# <br /> ¢�'��'� P.O.Box 66 <br /> O O' 2�50 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �� ir'�� �.�� Crystal Bay,MN 55323 <br /> �� s� i� y�t,�i% (952)249-4600 Approved By(If Required): <br /> �vt�o�!. <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 aaalication 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 mail within 2 business days. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Wark 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 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 wark 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 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 /> Job Site/Owner Information: <br /> � {� � <br /> Site Address: c.�c�tJ���� ( ��G�.D�� �\ i��� � c� �11 e <br /> Owner:.. �eGh� �;�,��n�i�� ,�,�?,�d�,��, Mailing Address: ��1�C�( ���S�r� ��CtC F:. <br /> , <br /> City: �C�E'�I F"i"��.;i'�; L Zip: ����i�� <br /> Home Phone: � Alternate Phone: ���vc'�fy,�"� �c�,�(� <br /> Contractor Information: <br /> Contractor: ��(��,�,��,�� .�� 1,-�{-, Contact Person: � �� . <br /> � <br /> Address: ��`i�( I ��U�-� �f'u/� State License#: J L/�/,� <br /> City: ��� Zip:�`.�,5.`_,��,Expiration Date: <br /> Phone: �'( �u�-�4�1�-; I DO Alternate Phone: (���- ��(�,c�_ �u<��� <br />