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� ,. �-� � z3��� <br /> FOR Cl 1'US�ONL1' <br /> ' �-�� �� Clty Of Ol'On0 Date Received� '��Permit# ��� ��� � <br /> � �1 P.O.Box 66 <br /> ��= <br /> ,% . � � <br /> 2750 Kelley Parkwa}' ❑ In-House SAC Detennination Form Completed <br /> ��\� ' Crystal Bay,MN 55323 <br /> i <br /> (952)249-4600 Approved By(If Required): <br /> ���'�-Ls't�o��� <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 subieet to further review and mav not be issued when the apn��cation ic received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail ar 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 wark must be done in accordance with State Code requirements. <br /> 8. All work must be inspected befare it is covered. Call (952)249-4600. 24+hour notiee required. <br /> TYPE OF'PERMIT <br /> �� � � (Checl� 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 �C t ��f .S f�r= �rd;�-Z <br /> Owner: ��fr C'�����t =J.I Mailing Address: � 7�-f L��al ��G`�- <br /> city: � ���« K - zip: �,;� .� Y.f <br /> Home Phone: Alternate Phone: �/L' S7�'�-�� � � <br /> Contractor Information: <br /> Contractor: !J<<{'iJ �'kr t�� - Contact Person: S1 r �--� �eci�-� <br /> Address: 3 y 7�' L��,� ,.,2.% State License #: j��� <br /> City: ��r Zip: rLr�• Expiration Date: <br /> Phone: �/Z�e�s '"YI��� Alternate Phone: `7�1 - %1f'-;J r�2 <br />