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(Updated 1/S/04) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 T�elley Parkway) SEWER/WATER & 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 shown below. Pemut 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 pernut 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 utiliry 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�vork must Ue 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: v�`� � � �S'"�'�S�1�V� �'�" � <br /> Occupancy Type: _�Residential Commercial <br /> Owner's Name: Phone Numbei-: <br /> Mailing Address: City: Zip: <br /> Contractor's Name: C�v\ Vv(r.�� �eJ�KSPhone Number: <br /> Mailing Addi•ess: �� City: C�YU�,� Zip: <br /> PERMIT TYPE Coiulections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate $1,350.00) $ (Set Rate) <br /> Sac Charge must accompany all sewer pennit applications uilless prepaid. <br /> (If not p�•epaid, � sewer connection will not be issued) � <br /> � �� ���✓/�`� � <br /> Municipal Sewer Connection/Disconne t/ epair ($35.00 per stub) $ � �� <br /> pipe size_�inches; material�Schd 40 air tested; cast iron � <br /> � <br /> Municipal Water Connection/Disconnect/�tepair($35.00 per stub) $ �1� ,(� <br /> , �� � <br /> pipe size �-�` inches; material_�/ copper; other /l <br /> WATER METERS must be picked up and paid for at City Hall. <br /> �� <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 tanlcs =75' <br /> REQUIRED setback from sewer line= 20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above pennit requested $ <br /> 2. State Surcharee $ .50 (Minimum) <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 & 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 t11is application are complete, e d correct. <br /> Signature of Applicant: ��� Date: 2l�"I <br />