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! <br /> FOR CITY USE ONLY <br /> O¢��0� City of Ot'ono Date Received: Pennit# <br /> P.O.Box 66 <br /> � „��; ti � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> 3 yj'�?�;..;. � Crystal Bay,MN 5�323 <br /> a �*�'�'��,o` 952 249-4600 Approved B If Re uired <br /> ���o�,� ( ) Y( 4 )� <br /> `-._...-�--i <br /> CITY OF ORONO—S�WER& WATER/G�NERAL PERMIT <br /> (*Note:Some permits may require approval by the Building OfYicial and/or Public Works Department') <br /> (ALL PERMITS- Mav be subiect to further revicw and mav not be issucd�rohen the anolication is received) <br /> GENERAL INFORMATION <br /> l. 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 tlle 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 1N ANY STREET AND DO NOT TAP ANY MAIN without express <br /> approval of the Public�Vorks 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 /> TYPC OF PERMIT <br /> Check All That A 1 ) <br /> �Residential(May Require Approval) � Commercial(Approval Rec�uired) <br /> �New Connection � Additionaf Connection �Re-Connection �� Repairs �Disconnect <br /> Job Site/Owner Information: <br /> Site Address: J ! � �/� ( ' �` (��l`� � <br /> Ownec:���Al.,� �Jf> ( I lvfG�"MailingAddress: <br /> City: � � �C " � Zip: <br /> � �� � ��� 7� �� <br /> Home Phone: � � 01 �S U � �� �7qlternate Phone: <br /> Contractor Information: <br /> Contractor: �J�`�F� G�(_ r 5�6ntFict l�erso: c ��'� ��� <br /> Address:�Y� �L,QG�� ��� State License #: /t� �f � -Q <br /> City: � ���U Zip.�����Expiration Date: <br /> Phone:��� � �� 3��� Alternate P11one: <br />