Laserfiche WebLink
(Updated 1/5/04) <br /> CITY OF OROlR�fl APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER & SAC <br /> . <br /> Crystal Bay, MN 55323 � `b� <br /> � ��\� ����` <br /> GENERAL INFORMATION � � � <br /> 1. You may apply for utility pernuts by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pei7nit cards will be sent by return mail the same day <br /> the a�plication 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 comlection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stuU as-built locations. DO NOT EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the Public Works Deparhnent. Issuance of a pemut 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: � � ��°"���5�� �i✓�� �� <br /> Occupancy Type: _��Residential Commercial <br /> Owner's Name: �- t�/�l'�;,�cr� ��`���'S Phone Number: <br /> Maili��g Address: City: Zip: <br /> Contractor's Name: v�i c�/ Pho►ie Numbe . �_,���7� - y�S� <br /> Mailing Address: �'� City: ✓1����� Zip: S'�3d <br /> PERMIT TYPE oimections ❑Repairs ❑Disconnect (Check One) <br /> SAC Cl�arge (2003 rate $1,350.00) $ (Set Rate) <br /> Sac Ch.arge must accornpany all sewer pennit 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 /> Muriicipal Water C nnection/Disconnect/R air ($35.00 per stub) $ <br /> pipe size�inches; material opper; otl�er <br /> —�� <br /> WATER METERS must be picked up and paid for at City Ha1L <br /> Water meters must be set and sealed by Orono Water Department <br /> (952-249-4600) upon completion of ineter installation. <br /> REQUIRED minimuin setbacks froin drain field and septic tanks= 75' <br /> REQUIRED setback from sewer line =20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above pennit requested $ <br /> 2. State Surchar�e $ .50 (Minimuin) <br /> The State Building Code Division Surcharge of$.50 per pernut must be <br /> included for each well,sewer and water connection pernut 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 Utility Permit, agrees to do all work in strict <br /> accordance with the ordinances of the City and the regulations of e St te of Minnesota, and certifies that all statements <br /> made on this application are complete, true and correct.. <br /> � <br /> Signature of Applicant: � Date: <br />