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(Updated 1/5/04) <br /> yL'IT�'-flF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Bay,MN 55323 <br /> GENERAL INFORI�IATION <br /> 1. 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 be sent by return mail the same day <br /> the application is received. <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 pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND <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 /> � <br /> JOB SITE ADDRESS• ��S � �•'?� . ���' ' �T• <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: n y�l,^y�y - ilvr� �' Phone Number: <br /> Mailing Address: City: Zip: <br /> Contractor's Name: �,, ;� �,i� S• � Phone Number: (�s'�� �7,� -S/S�`j <br /> Mailing Address: �� J/ C�. ��c�_ /,.�`°`�, City: �,.�.�� Zip: 5�3��/� <br /> PERMIT TYPE �onnections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate $1,350.00) $ (Set Rate) <br /> Sac Charge must accompany all se�ti�er permit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Municipal Sewe . o ection/Disco�q���e,,e�{Repair($35.00 per stub) $ <br /> pipe size inches; mate �- Schd 40 air tested; cast iron <br /> Municipal Water ection/Disco ec epair ($35.00 per stub) $ <br /> pipe size inches; material copper; other <br /> l <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 = 75' <br /> REQUIRED setback from sewer line=20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 (Minimum) <br /> The State Building Code Division Surcharge of$.50 per permit must be <br /> included for each well, sewer and„�ater connection pernut requested. <br /> 3. Postage & Handling(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 Utility Permit, agrees to do all work in strict <br /> accordance with the ordinances of the City and the regul ' ns of the State of Minnesota, and certifies that all statements <br /> made on this application are complete, true and co <br /> Signature of Applicant: Date: ��/� <br />