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. <br /> FqR CITX USE ONLY <br /> �4-��1\�� Clty of OrOno Date Received:� Permit#�l b- �' <br /> �' � '4 P.O.Bcx 66 �� <br /> j �(- i 2750 Koliey Parkway ❑In-House SAC Determination FormC�,qmpleted <br /> i,�\t �� Crystal 3ay,MN 55323 j,�' � <br /> �,�'��¢F� (952)249-4600/Fau(952)249-4616 Approved By(If Required): �P/�G'�' <br /> �Ac-snc � <br /> CITY OF ORONO—SEWER& WATER/GENERAL PERMIT <br /> (*Note:Som�,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 aoolication 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 appl;cations are subject to the postage and handling fee shown below. Permit cards will <br /> be sent by retw-n mail within 2 business days. <br /> 3. Permits are n��t 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 Apply) <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: J��g� /�'diQ,� �i��� �2 . <br /> Owner: �/e�� �euC�N,�1��' Mailing Address: %�3/� ��,��y <br /> c�cy: _ ��yMe� z�p: ��yy 7 <br /> Home Phone: rl�2 �sd?1��5��8� Alternate Phone: <br /> Contractor Information: <br /> Contractor: Q:�,M� ��''A�'�✓L �/�lL� Contact Person: /�%� 1�4�i/�•�✓b <br /> Address: �iv9 �JSt � State License#: <br /> City: ��✓L,S Zip:S�dt� Expiration Date: <br /> Phone: /?� g/9 �3'�� /�) Alternate Phone: D�",c�: �S/ �/�d./3�S'� <br />