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• Sep 13 04:59a Knapp and Sons Septic LLC 320-369-3795 p.1 <br /> � • <br /> FOR CITY USE ONL��Y�r� p <br /> .1�Un/� Clty Of O�"OIIo Date Receiv��Permit uc�Y/ • /�� <br /> P.O.Box 66 <br /> � 2750 Kdley Parkway ❑In-House SAC Detecmination Form Complaed <br /> - � i � � Crystal Bay,MN 55323 <br /> ',, ,�!� �: (952)249-460D/Fax(952)249-4616 Approved By(If Raquited): <br /> A.J�:1��:- <br /> CITY OF OR4N0—SEWER& WATER/GENERAL PERMIT <br /> (*Yote:Some permits may require apptoval by the B�eilding Official andlor Public Wodcs Department�) <br /> !AI 7 PFRMiT5- Mav be subiect to furtber r iew and mav not be issued w�bee the aoulication is receivedl <br /> GENERAL�NFORMATION <br /> 1. You may apply for utility permits by mail or in person ax the City of['ices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will <br /> be sent by return maiE 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 pennits may be issued to licensed contractors only. <br /> 6. Contact the Public 1�'orks Deparimen2(952-249-460U)for utility stub as-buik locations. <br /> DO NOT EXCAVATE IN.A1�1'STREET AND DO NOT TAP ANY MAIN withont ezpress <br /> approvaf otthe Public VVorks Department. Issuance of a permit dces not grantthis 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. Cail(952)24913600,1A+tiour notice required. <br /> TYPE OF PERMIT <br /> Chec3c All That A 1 <br /> ❑Residential(May Require Approval) ❑Commercial(Approval Required) <br /> �New Connection ❑Additional Connection �Re-Connection ❑Repairs ❑Disconnect <br /> ❑ 1Vater Availability Connection For Future Hook-Up to Water <br /> Job Site/Ov►mer Information: <br /> Site Address: f�� � :/�/�Ur�-� ,,�,�f-,., �� `•, <br /> Owner:�ho��,.! ;�,��,-,�,r.,4,,, Mailing Address: <br /> City: Zip: <br /> Home Phone: Altemate Phone: <br /> Contractor Information: <br /> Contractor. �nu�7 �n�l' 4�ns �c. Contact Person: ��J c;•C- � <br /> Address: �;�5`7`� �1v�`h Sr�. State License#: /���5/y�3��R <br /> � <br /> City: /j"/� �Gc�, Zip�/I.il/ Expiration Date: %�� 3i -�fi/� <br /> Phone: � G�.� Alternate Phone: 7G 3- �'77- ��S�G <br />