Laserfiche WebLink
(iTpdated 1/5/04) <br /> �IT'�OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORMATIO\ <br /> 1. You may 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 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 NOT EXCAVATE IN ANl'STREET AND <br /> DO NOT TAP ANY�1AIN without express approval of the Public Works Department. Issuance of a permit does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 3. All work must be inspected before it is covered. Call(952)249-4600,24 hour notice required. <br /> � / <br /> JOB SITE ADDRESS: �-� ���P "�� r P <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: �' N 7�?�,��,,« ���� Phone Number: <br /> Mailing Addres�— City: __ Zip: <br /> Contractor's Name: �s �r, � � Phone Number: S� 7.� � �/ S�7 <br /> Mailing Address: (�SU( �'D_ r�'� . �� City: �Y/ar� �� � Zip: 5�3���y <br /> PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate 51,350.00) $ (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� Schd 40 air tested; cast iron <br /> Municipal Water Connection/Disconnr��pair($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 = 75' <br /> REQUIRED setback from sewer line=20' <br /> PERMIT FEE CALCUL�TION <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 (Minimum) <br /> The State Building Code Division Surcharge of 5.50 per permit must be <br /> included for each well,sewer and water connecrion permit requested. <br /> 3. Posta�e & 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 Pertnit, agrees to do all work in strict <br /> accordance with the ordinances of the City and the re 1 ' ns of the State of Minnesota, and certifies that all statements <br /> made on this application are complete, true and co ect <br /> Signature of Applicant: Date: �� <br /> i <br /> �f� �� C�s,�� l,�l�� 7�/- �7�I` <br />