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(ITpdated 1/5/04) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Bay, MN 55323 <br /> GENERAL`INFORNIATION <br /> 1. +You may apply for urility pemuts 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 return 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 pemut card is available on the job site. <br /> 5. Utility connection pernuts may be issved to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANl'STREET AND <br /> DO NOT TAP AI�'Y 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 � � r�� <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: ;�� �2 �,��r4�, �e lt��:�,�S Phone Number: <br /> NTailing Address: City: Zi : <br /> Contractor's Name: ,.� Phone Numb : '.� �(7 - `/S.S 7 <br /> Mailing Address:��S�( � , t/' � City: M�,�v� _ Zip: Ss36� <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 Connection/Disconnect/Repair($35.00 per stub) $ <br /> pipe size f inches; material�Schd 40 air tested; cast iron <br /> Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $ <br /> pipe size '7 inches; material C 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=75' <br /> REQUIRED setback from sewer line= 20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surcharee $ .50 (Minimum) <br /> The State Building Code Division Surcharge of$.50 per pernut must be <br /> included for each�vell,sewer and water connection pernut 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 Utility Permit, agrees to do all work in strict <br /> accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements <br /> made on this application are complete, true and c ect. <br /> � <br /> Signature of Applicant: Date: 3 �� <br />