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(Updated 1/5/04) <br /> CITY OF ORONO APPLICATION FOR UTILI'T�i'PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Bay, ? v 55323 <br /> � <br /> GENERAL INk'ORMATION <br /> 1. You inay apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applicarions are subject to the postage and handling fee shown below. Permit cards will be sent by retum mail the same day <br /> the applicarion is received. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the pernut card is available on the job site. <br /> 5. Utility connection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locarions. DO\OT EXCAVATE IN ANY STREET:�.�ID <br /> DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a pernut 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 /> JOB SITE ADDRESS: C�3 �-�i ►'��"��Oo�t� �%/� <br /> Occupancy Type: ���Residential Commercial <br /> Owner's Name: Phone Number: <br /> Mailing Address: City: Zip: <br /> Contractor's Name: •� -� `7 . � ' � Phone Number: S - � <br /> Mailing Address: , �� • Cit3': �, Zip: ��:36/ <br /> PERMIT TYPE �'Connections ❑Repairs ❑Disconnect (Check One) <br /> � <br /> SAC Charge (2003 rate $1,350.00) $ (Set Rate) <br /> Sac Charge must accompany all sewer permit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer Connection/Disconnect/Repair($35.00 per stub) $ <br /> pipe size�inches; material���chd 40 air tested; cast iron <br /> 7�— <br /> Municipal Water Co�nection/Disconnect/Repair ($35.00 per stub) $ <br /> pipe size '� inches; material�-copper; other <br /> WATER METERS must be picked up and paid for at City Hall. <br /> Water meters must be set and sealed by Orono Water Department <br /> (952-249-4600) upon completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field and septic tanks= 7�' <br /> REQUIRED setback from sewer line=20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surcharae $ .50 (Minimum) <br /> The State Building Code Division Surcharge of$.50 per permit must be <br /> included for each well,sewer and water connection permit requested. <br /> 3. Postage & Handlin� (Only mail-in applications) $ 1.50 (Mail In Only) <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ <br /> The undersigned hereby applies to the City of Orono for issuance of a UtilityF Permit, agrees to do all work in strict <br /> accordance with the ordinances of the City and the regulatio f the State of�linnesota, and certifies that all statements <br /> made on this application are complete, true and correc <br /> � �, <br /> Signature of Applicant: �-�'� Date: ���--��� <br />