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FO�E ONLY y/� <br /> � 04��0 City of OCono Date Received: ermit# �Q—'� /(�a2 <br /> P.O.Box 66 <br /> �, ; 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> � , �� i`' Crystal Bay,MN 55323 <br /> ��` ��ya� (952)249-4600 Approved By(If Required): <br /> y�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 anplication 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. 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 pernut 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 pernut 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 OF PERMIT <br /> (Check All That Apply) <br /> ❑ Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> � New Connection ❑ Additional Connecrion ❑Re-Connection ❑ Repairs ❑ Disconnect <br /> :p�] Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: y 5 .��v,����1f,� Rn <br /> Owner: �?Q55: �t�����,,,� Mailing Address: �-{ 5 M����\wr,t�c� <br /> City: Oi-c�,�r'; Zip: <br /> Home Phone: q 5.1- �{��,-��)S Alternate Phone: <br /> Contractor Information: <br /> Contractor: C-c�� 5�..:r� �- �.:x4.�:' Contact Person: Q-\\ c�P�.(� <br /> Address: ��,y�,yu�:` „o�� State License#: 5 73 a`�- ,^1f� <br /> City: i,J�.�4ec��.,,r� Zip:�3� Expiration Date: j,a,-;j'�_ pq <br /> Phone: �5��-y SS'- �5`c3� Alternate Phone: 6\�- 5�A - `1`1�`i <br />