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(LTpdated 1/5/04) <br /> r�TY OF ORONO APPLICATION FOR UTILITY PERVIITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORNIATION <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. Pernut cards will be sent by retum mail the same dati� <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 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. DO\OT EXCAVATE IN A.VY STREET AI`� <br /> DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a permit does not grant this approva� <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: .�'��� � ���' ��� <br /> Occupancy Type: Residential Commercial <br /> Owner's Name:_�_ �vi j'r�ff��<<? /�'��'S Phone Number: <br /> Mailing Address: City: Zip: <br /> Contractor's Name: c•O � Sr Phone Number: � - � <br /> Mailing Address: (�SCf fc,^ �� ,S City:���G„1 ip:�,��� <br /> PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One) <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 yj�ection/Disconnect/R air ($35.00 per stub) � <br /> pipe size���__ `nches; material�chd 40 air tested; cast iron <br /> Municipal Water n ction/Disconnect/R r($35.00 per stub) $ <br /> pipe size mches; material = copper; other <br /> WATER METERS must be picked up and paid for at City Hall. <br /> �Vater 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 S <br /> 2. State Surchar�e $ .50 (Minimum) <br /> The State Building Code Division Surcharge of$.50 per pernut must be <br /> included for each well,sewer and water connection permit 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�he regulations of the State of Minnesota, and certifies that all statementt <br /> made on this application are complete, t �,correct. <br /> - r, <br /> Signature of Applicant: Date: �� <br />