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Doc-04-1001 12:4dpm From-CITY OF ORONO +pg22464616 T-2G7 P.001/001 F-305 <br /> tU�+4Yl1eY LIl14/U1J <br /> �. <br /> � CITY OF ORONO A.PPL�CATION FQR UTILITY PER,MTTS <br /> Box 6d(2750 KaUay Parkway) S�WEI2/WATER <br /> Crystal�ay,MN SS323 <br /> CLNE L.INFORMATYON <br /> l. You may sppty for util[ty permits by rna[1 ar i��persan at the Ciry ot�ices. <br /> 2, Mailed in applicaiions are aubject to the postage and handlin�fee showa below. Permit cards wilt be sent by <br /> raturn mail tha same tlay the applieation is recr.ived. <br /> 3, Perm3t�are not vxlid until yon receivu s permit card. <br /> 4. �Vork must not begin unless the permit cerd ia available on the job site. <br /> S. Utility connection perruits may be issued to licensed c�ontmotors only. <br /> 6, Coatact the Public Works Department (95?�249-4600) far utility stub as-bnilt latations. pQ NQT <br /> EXC/�VATE IN ANY STRE�T AND DO NGT TAP ANY MAIN witho�t express approval of the Public <br /> Woiics DeparomenL Issuance of a permit doos not @ant this approval. <br /> 7. AlI wark muet be done;n aecordenee with Sta�o Code roquiremeats. <br /> , 8. AA wark must b�insp�cted before it is covere�l, Gtll(452)�49-4600. <br /> 24 hour noiiee reqnired. <br /> .ro�a s�r�r,�n�a�ss: I rl �-�t�, `--�IZc��.��c ���. ���;�- <br /> Oocup�cy T`ype:_ '� Residentiai Commercial <br /> Uvruer'�Name; `�7`�--':t :���-� -�.�,,_�-�s-__� Phoae Number: <br /> Maeliu��Addr�9: �l�t��,�,d, �� . � Citp: C-�< ��_��, 7� <br /> Contrictor'a Name: . ., . � _ � PLanc Number:_ `i`�<�� `����`) <br /> Mailin�Addresa:l�� � \i ,� �;�.r y�� �_ ,� City: �ti�.-+�'���. �i: '��=���� <br /> P�12MYT TYP� <br /> Muaicipal Sewer Coanection($35A0 per stub) $ ���,C;�� <br /> 1/e��� pipe si�c�inch�es; materi�I,,,,�,,,Schedule 40 air tested; cast iron <br /> a`""'�°`' SAC Charge�2000 rate$1,150.Q0)must gccoiupan�atl sewtr peamit applications wiless prepaid <br /> �' r If not prepaid,a sewer co�.n.ection permit will�wt be issued. <br /> lVtuntcipal'VKAter Connoction{$35.00 per stub) >>-'�'� ` � c ��. $ <br /> pipe siu inah ; matcrial copper; other <br /> WAT'ER METE�S must picked up and paiil for at City Hall. <br /> Wxter met�rs mu3� bc ct xn$ seaied by (►rono Water Department (952-?,49-46p0) upon <br /> completfon of inettr statllation. <br /> REQ ' um sctbacks from drain field and septic tanks�75' <br /> REQ set6a�tic�om scwcr l�ne=�U' <br /> PFB�XT FF;;�;�'�Lb'I,7�� <br /> 1. ��1�tot�s�f abc+�r�per.�:t rtqu�stcd $ '�>>,C�� <br /> 2. Stata Surc�e $ .SQ - <br /> T7�e Stata HuiEding Codc l7ivIsion Surchargo ai'$.SO per permit must ba <br /> inaluded for oaah well,sawer and water aonna<:tion permit rcquQsted. <br /> 3. PastaQe&�andlir�g(4nly mail-in applications) $W -� <br /> 4. TOTA.L PERMIT FEE(add linos 1-3 above} $ ��,��, <br /> The uadersigned hereby applies to the City of�hono for iasuance af a Utility Penni�, agrccs ta do <br /> all work in sttfCt accordt�ttct with thc ordinances of the Cifiy and the regulations of the State of <br /> Minncsota�and certif es that all statcments made on this�a}�plication are complete,true an�i correct. <br /> � �` <br /> Signature of Applicant�L�, �2 �� :,�--E���Z ,�-(.� , ��. � _ ?a. <br />