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�'� (Updated 1/5/04) <br /> CITY �j�F ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 6f�(2750 Kel,ley Parkway) SEWER/WATER & SAC <br /> Crystal Ba�, N1N 55323 (� � <br /> �� r��1�° ,���. <br /> GENERAL INFORMATION Q V �\ '� <br /> 1. You may apply for utility pemuts by inail or in person at the City of�ces. �� � <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pennit 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 peniut card is available on the job site. <br /> 5. Utility comiection 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 Deparnnent. Issuance of a pemut does not grant this approvaL <br /> 7. All work nuist be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600, 24 liour notice required. <br /> , � <br /> JOB SITE ADDRESS� ����� f'�- <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: —�7�r,��.,�> �a,�� Phone Numbei: <br /> Mailing Address: City: Zip:_ <br /> Contr�ctor's N1me: � v�./ Phone Number• aS� u7��� <br /> Mailing Address: �d( �'O . .P_ -� f-� City: ►'�'C���� `� Zip: 5`� 36�/ <br /> PERMIT TYPE �onnections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate $1,350.00) $ (Set Rate) <br /> Sac Charge must accompany all sewer pennit applications unless prepaid. <br /> (If not prep�id, a sewer connection will not be issued) <br /> Municip�l Sewer onnection/Disconnect/Re air ($35.00 per stub) $ <br /> pipe size�inches; material�chd 40 air tested; cast iron <br /> Municipal Water C nnection/Disconne 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 CALCULATION <br /> 1. SuUtotal of above pennit requested $ <br /> 2. State Surchar�e $ .50 (Minimum) <br /> The State Building Code Division Surcharge of$.50 per pernzit must be <br /> included for each well,sewer and water connection pemut requested. <br /> 3. Posta�e &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 regulations of th State of Mirulesota, and certifies that all statements <br /> made on this application are complete, true a�d correct. <br /> Signature of Applicant: Date: <br />