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(Updated 1/5,04) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORMATION <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 return mail the same day <br /> the appiicarion 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 Warks Department(952-249-4600)for utility stub as-built locarions. DO NOT EXCA�':1TE IN AI�'Y STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the Public Works Deparm�ent. 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)249-4600,24 hour notice required. <br /> JOB SITE ADDRESS: ` b�� ���4�" w c�o �� <br /> Occupancy Type: x Residential Commercial <br /> Owner's Name: � �, ���/�� ? Phone Number: <br /> Mailing Address: City: _ Zip: <br /> Contractor's Name: ��'�,l! �c,� Phone Number: �� �-l7� - <br /> Mailing Address: �sv� C�. ��� . ��`� City: Zip: <br /> PERMIT TYPE ❑ Connections �epairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate $1,350.00) S (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) S <br /> pipe size L inches; material� Schd 40 air tested; cast iron <br /> Municipal Water Connection/Disconnect/Repair($35.00 per stub) S <br /> pipe size inches; material copper; other <br /> WATER METERS must be picked up and paid for at City Hall. <br /> Water meters must be set and sealed by Orono Water Department <br /> (952-249-4600) upon completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field and septic tanks = 75' <br /> REQUIRED setback from sewer line=20' <br /> PERMIT FEE CALCULATION <br /> l. Subtotal of above permit requested S <br /> 2. State Surchar�e S .50 (Minimum) <br /> The State Building Code Division Surcharge of$.50 per permit must be <br /> included for each well,sewer and water connection permit requested. <br /> 3. Postage & Handling(Only mail-in applications) S 1.50 (Mail In Onlv) <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) S <br /> The undersigned hereby applies to the City of Orono for issuance of a litility Permit, agrees to do all wor� 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 orre . <br /> � � . <br /> Signature of Applicant: Date: �� � <br />