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� � <br /> FOR CITY USE ONLY <br /> �t��/�,/�J Clty of OConO Date Received: Permit# <br /> P.O.Box 66 <br /> i /�� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> �� Crystal Bay,MN 55323 <br /> %�`�'� . (952)249-4600/Fa�c(952)249-4616 Approved By(If Required): <br /> ��, <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 aaulication is receivedl <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 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 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 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 A I <br /> ❑Residential(May Require Approval) ❑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: ���,a �/ ���y r t� ���i o r� �('� v-� <br /> Owner: �l1 CS'S�r� ���},.y,�S Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> � � �;` .� <br /> Contractor: 1'�»van u„�Q �S�:,s ��' Contact Person: � q <br /> Address: ��-5 ��/ //U�`' S�. State License #: ?�/� �v L'�4�,�Q °� <br /> ,� <br /> City: ��/"���,�,,L�Zip:`� �'3��xpiration Date: J 3 � c�(1 �' � <br /> Phone: �C .�- y 7 7—�.� Z�( Alternate Phone: <br />