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�_� FOR CI'CY USE ONLY <br /> f a CltyOt��1'On0 Date�Received: � Permit# <br /> /�¢ �Q\ P.O.Box 66 <br /> � 2750 Kelley Park���a}' ❑�In-1 fouse SAC�Determination Form Completed <br /> ��� ��� �'n.;� Crystal Bay,MN 553'_3 � � <br /> ���,t��;j��u`� (952)249-4600 Approved By(If Required): <br /> �`ais'so$ <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> � (�'Note:Somc permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PER�1ITS- Dia��be subiect to 4irther review and mav not be issued when the aoplication is received) <br /> GENERAL 1NFORMATION <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 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 Worl<s 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 permit does not grant this approval. <br /> 7. All warl<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 Approva]) ❑Commercial (Approval Required) <br /> ❑ New Connection ❑Additional Connection �Re-Connection ❑Repairs ❑ Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: � �� S NC�r �� �hd r{', ��'. <br /> Owner: �% /✓�� ���: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: � <br /> Contractar: �O l �� y � �Urt S Contact Person: �'��� ����� <br /> Address: ����1 �'c> �� � State License#: ./��/� � ���� <br /> �1����r <br /> City: �l� S Zip:�,_7�j Expiration Date: o?" �`� �� <br /> � . / l l��o <br /> Phone: �s�" �5� �/�3_� Alternate Phone: �/������ <br />