Laserfiche WebLink
(ilpdated 1/5/04) <br /> CI+�Y OF ORONO APPLICATION FOR UTILITY PERl�IITS <br /> Box 66 (2750 Kelley Parkway) SEWER/`�:-�TER& SAC <br /> Crystal Bay, MN 55323 <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 showv below. Permit cards�izll be sent by ret�n 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 permit card is available on the job site. <br /> 5. Utility connection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locarions. DO NOT EXCAVATE Iti�`�TY STREET AND <br /> DO NOT TAP ANY MAIN 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 /> 8. All work must be inspected before it is covered. Call(952)249-4600,2�3 hour notice required. <br /> JOB SITE ADDRESS: �7 7� S� ��?�/�•����� �J� <br /> Occupancy Type: � Residential Commercial <br /> Owner's Name:__ �� ��y�,��� /�,�� �S Phone\umber: <br /> Mailing Address: City: _ Zip: <br /> Contractor's Name: �� �� � Phone\umber: v�7.-� �- " 6 6 <br /> Nlailing Address: �;�S6f c� , , �S- City:__;���.� �J Zip: 5-�-3��' <br /> PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One) <br /> � <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�inches; material� Schd 40 air tested; cast iron <br /> Municipal Water Connection/Disconnect/Repair($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 /> `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 = 75' <br /> REQUIlZED setback from sewer line=20' <br /> PERMIT FEE CALCULATION <br /> l. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 (vlinimum) <br /> The State Building Code Division Surcharge of$.50 per permit must be <br /> included for each well,sewer and water connection permit requested. <br /> 3. Posta�e &Handling (Only mail-in applications) $ 1.50 (Llail 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 Pernut, 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 co ct. <br /> Signature of Applicant: Date: 2� � <br />