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! <br /> � , <br /> � FOR CITY USE ONLY <br /> ,¢0� City of�ron0 Date Received: Permit# <br /> O^ O P.O.Box 66 <br /> �;;,� 2750 Kelley Parkway ❑ In-House SAC Determination Form Completed <br /> � ��i�?�,e`'. F Crystai Bay,MN�5323 <br /> ��t';;?�k��$�o� (952)249-4600 Approved By(If Required): <br /> '�esxo <br /> CITY OF ORONO— SEWER & WATER/ GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official andlor Public Works Department*) <br /> (ALL PERMITS- Mav be subiect to further review and ma��not be issued when the annlication is received) <br /> � GENERAL INFORMATION <br /> 1. You inay apply for utility pernuts by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut 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 peinut 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 requireinents. <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 Ap ly) <br /> [�Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection ['r Re-Connection ❑Repairs ❑ Disconnect <br /> Job Site/ Owner Information: <br /> Site Address: � �Vo�-1 h �,��or� �- <br /> �M_ '�— <br /> Owner: �(, � � �� � Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ���--�������� Contact Person: ��s5 `�Ze�j�i�'v��� <br /> Address: 1�v�j �,���J� State License #: Cv�D <br /> City: /�'f N Zip: 5a�3y� Expiration Date: <br /> Phone: �(�,3— �(�-1/—�t�3�, Alternate Phone: �,�2—�4��,--:��83 <br /> � <br /> � <br /> ,: <br /> � <br /> � <br /> 5 � <br />